Prognostic Value of High-Sensitivity Troponin T After On-Pump Coronary Artery Bypass Graft Surgery
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Updated: Nov 7, 2025
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Published on: September 15, 2023
Jessy A Nellipudi1, Robert A Baker1, Lukah Dykes2
1Department of Cardiothoracic Surgery, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
Insights
High-sensitivity troponin T (hs-TnT) levels after coronary artery bypass graft (CABG) surgery predict major adverse cardiac or cerebrovascular events (MACCE) and 30-day mortality. Elevated hs-TnT is linked to increased risk of MACCE, myocardial infarction, and prolonged ICU stays.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomarkers
Background:
- High-sensitivity troponin T (hs-TnT) is a valuable biomarker for assessing myocardial damage.
- Its widespread availability makes it attractive for predicting postoperative outcomes.
- The prognostic value of hs-TnT after coronary artery bypass graft (CABG) surgery requires further investigation.
Purpose of the Study:
- To determine the prognostic value of hs-TnT in predicting in-hospital outcomes following CABG surgery.
- To assess the association between peak hs-TnT levels and major adverse cardiac or cerebrovascular events (MACCE).
- To evaluate the predictive capability of hs-TnT for 30-day mortality, myocardial infarction (MI), and stroke post-CABG.
Main Methods:
- A retrospective analysis of 1,318 patients undergoing on-pump CABG between July 2011 and December 2018.
- Postoperative hs-TnT levels were measured at 0, 6, 12, and 72 hours, with peak values assessed within 24 hours.
- Bayesian logistic regression was used to analyze the association between hs-TnT levels and adverse events, including MACCE.
Main Results:
- An increasing odds ratio (OR) for MACCE, 30-day mortality, and MI was observed with rising hs-TnT levels (p<0.001).
- Peak hs-TnT levels >400 ng/L were significantly associated with MACCE, 30-day mortality, MI, and ICU stay >48 hours.
- No significant association was found between hs-TnT levels and stroke, ICU readmission, return to theatre for bleeding, or new-onset renal dysfunction.
Conclusions:
- Peak hs-TnT levels within 24 hours post-CABG are significant predictors of MACCE, 30-day mortality, MI, and prolonged ICU stay.
- hs-TnT demonstrates prognostic value in identifying patients at higher risk for adverse outcomes after CABG.
- Further prospective studies are recommended to fully elucidate the prognostic role of hs-TnT in the post-CABG setting.
Introduction:
High-sensitivity troponin T (hs-TnT), as a single or serial measurement to predict postoperative mortality and morbidity, appears to be attractive due to its direct relationship in assessing myocardial damage and the widespread availability of hs-TnT testing. Therefore, this study aimed to identify any prognostic value of hs-TnT in predicting in-hospital outcomes after coronary artery bypass graft (CABG) surgery.
Method:
We identified all consecutive patients who underwent on-pump CABG between July 2011 and December 2018. To evaluate the prognostic value of hs-TnT after CABG, we assessed the probability and odds ratio (OR) of adverse events concerning the maximum value of postoperative hs-TnT (measured within 24 hrs). TnT was routinely collected at 0, 6, 12 and 72 hours postoperatively. Values were categorised into intervals of 200 for analysis. A fully Bayesian logistic regression of the adverse event with the troponin T interval (0-200) as the reference level was used. A subgroup analysis was performed in patients with normal and elevated preoperative hs-TnT (< or ≥30 ng/L). The pre-specified primary outcome was a major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of death within 30 days of operation for any cause, myocardial infection (MI), or stroke.
Results:
1,318 people underwent on-pump CABG during this period. One hundred and twenty-three (123) (9.3%) experienced MACCE, 14 (1.1%) experienced death within 30 days, 105 (8.0%) experienced MI and 14 (1.1%) experienced stroke. Compared to the reference category (hs-TnT ≤200 ng/L) we found there was an increase in OR with increasing level of hs-TnT for MACCE (p<0.001), 30-day mortality (p=0.003), MI (p<0.001) and ICU stay >48 hours (p<0.001). However, there was no statistically significant association present between hs-TnT and stroke, readmission to the intensive care unit (ICU), return to theatre for bleeding, or new-onset renal dysfunction.
Conclusion:
Peak hs-TnT level, greater than 400 ng/L, measured within 24 hours after CABG surgery is associated with MACCE, 30-day mortality, MI and ICU stay >48 hours. Prospectively designed trials, with clear prognostic and outcome variables, may provide further insight into the prognostic value of hs-TnT post-CABG.
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