Impact of troponin I level on coronary artery bypass grafting outcomes
Emma J Morone1, Shawn J Barker1, Carlos R Martinez Licha1
1Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Insights
Elevated preoperative cardiac troponin I (cTnI) levels before coronary artery bypass grafting (CABG) increase adverse outcomes but not mortality. The timing between peak cTnI and CABG surgery does not impact results.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomarkers
Background:
- Preoperative cardiac troponin levels are increasingly used to assess cardiac injury.
- The prognostic value of cardiac troponin I (cTnI) before coronary artery bypass grafting (CABG) remains unclear.
- Understanding the impact of cTnI levels and timing is crucial for optimizing CABG outcomes.
Purpose of the Study:
- To investigate the effect of preoperative cardiac troponin I (cTnI) levels on outcomes after coronary artery bypass grafting (CABG).
- To determine the impact of the time interval between maximum cTnI and surgery on CABG outcomes.
Main Methods:
- Retrospective analysis of 608 patients undergoing isolated CABG (2009-2016) with available preoperative cTnI.
- Receiver operating characteristic (ROC) analysis to establish a cTnI threshold.
- Comparison of outcomes between groups defined by the cTnI threshold.
Main Results:
- A cTnI threshold of 5.74 µg/dL was identified as associated with worse outcomes.
- Patients with peak cTnI >5.74 µg/dL had higher risk of adverse events and longer hospital stay.
- No significant association found between cTnI levels and mortality or 30-day readmission.
- Time interval between peak cTnI and surgery did not influence outcomes.
Conclusions:
- Elevated preoperative cTnI above a specific threshold is linked to adverse postoperative outcomes in CABG patients.
- cTnI level is not a predictor of mortality or 30-day readmission.
- The timing between peak cTnI and CABG surgery does not appear to affect outcomes and may not require consideration in surgical planning.
Purpose:
The effect of preoperative cardiac troponin level on outcomes after coronary artery bypass grafting (CABG) is unclear. We investigated the impact of preoperative cardiac troponin I (cTnI) level as well as the time interval between maximum cTnI and surgery on CABG outcomes.
Methods:
All patients who underwent isolated CABG at our institution between 2009 and 2016 and had preoperative cTnI level available were identified using our Society of Thoracic Surgeons registry. Receiver operating characteristic (ROC) analysis was performed to identify a cTnI threshold level. Subjects were divided into groups based on this value and outcomes compared.
Results:
A total of 608 patients were included. ROC analysis identified 5.74 µg/dL as the threshold value associated with worse postoperative outcomes. Patients with peak cTnI >5.74 µg/dL underwent CABG approximately 1 day later, had twice the risk of adverse postoperative events, and had 2.8 day longer postoperative length of stay than those with peak cTnI ≤5.74 µg/dL. cTnI level was not associated with mortality or 30-day readmission. Time interval between peak cTnI and surgery did not affect outcomes.
Conclusion:
Elevated preoperative cTnI level beyond a certain threshold value is associated with adverse postoperative outcomes but is not a marker for increased mortality. Time from peak cTnI does not affect postoperative outcomes or mortality and may not need to be considered when deciding timing of CABG.
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