High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality
P J Devereaux1, Andre Lamy1, Matthew T V Chan1
1From McMaster University (P.J.D., A.L., M.H.M., E.P.B.-C., N.D., D.C., P.A.K., M.J.M., J.S., Y.L.M., R.M., S.F.L., S.I.B., S.H., F.K.B., G.H.G., S.Y., R.P.W.), Hamilton Health Sciences (P.J.D., A.L., E.P.B.-C., N.D., D.C., P.A.K., Y.L.M., F.K.B., G.H.G., S.Y., R.P.W.), and the Population Health Research Institute (P.J.D., A.L., M.H.M., E.P.B.-C., D.C., M.J.M., K.B., J.S., Y.L.M., R.M., S.F.L., S.I.B., F.K.B., S.P., J.V., S.Y., R.P.W.), Hamilton, Queen's University, Kingston (R.V.A., J.L.P.), and Sunnybrook Health Sciences Centre and the University of Toronto, Toronto (S.C., S.F.) - all in Ontario, Canada; the Chinese University of Hong Kong, Hong Kong (M.T.V.C., M.J.U.), and the First Affiliated Hospital of Xinjiang Medical University, Urumqi (H.Z.) - both in China; E. Meshalkin National Medical Research Center (V.V.L., M.A.) and Novosibirsk State University (V.V.L.), Novosibirsk, and the Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo (D.S.) - all in Russia; IRCCS San Raffaele Scientific Institute (G.L., E.F., F.M.) and Vita-Salute San Raffaele University (G.L., F.M.), Milan, the University of Foggia, Foggia (D.P.), and Santa Maria Hospital GVM Care and Research, Bari (D.P., V.M.) - all in Italy; the University of Malaya, Kuala Lumpur, Malaysia (C.Y.W.); Hospital de la Santa Creu i Sant Pau (G.U., M.M.) and Institut d'Investigació Biomèdica Sant Pau-CIBERESP (G.U.) - both in Barcelona; Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo (L.A.H.), and Hospital Moinhos de Vento (C.A.P.), Hospital de Clínicas de Porto Alegre (C.A.P.), and Instituto de Cardiologia do Rio Grande do Sul (R.S.), Porto Alegre - all in Brazil; Royal Perth Hospital and the University of Western Australia - both in Perth (G.S.H.); the University of Edinburgh, Edinburgh (N.L.M.), the Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool (J.D.M.), and the Royal Wolverhampton NHS Trust, Wolverhampton (J.S.B.) - all in the United Kingdom; the University of California, Los Angeles, Los Angeles (E.M.); the University of Arizona College of Medicine, Tucson (J.S.A.); and Auckland City Hospital and the University of Auckland - both in Auckland, New Zealand (H.D.W.).
Cardiac surgery guidelines for troponin elevation thresholds lack evidence. This study found significantly higher troponin I levels associated with 30-day mortality, suggesting current definitions of perioperative myocardial injury may be too low.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomarkers
Background:
- Current consensus recommendations for defining perioperative myocardial infarction and injury after cardiac surgery have wide-ranging troponin elevation thresholds.
- Limited evidence supports these existing recommendations, necessitating further investigation.
Purpose of the Study:
- To investigate the relationship between high-sensitivity cardiac troponin I (hs-cTnI) levels and 30-day mortality after cardiac surgery.
- To determine evidence-based threshold levels of troponin elevation associated with increased mortality risk.
Main Methods:
- An international prospective cohort study included 13,862 adult patients undergoing cardiac surgery.
- High-sensitivity cardiac troponin I levels were measured post-surgery (3-12 hours and days 1, 2, 3).
- Cox regression spline analysis explored the association between peak troponin levels and 30-day mortality, adjusted for the European System for Cardiac Operative Risk Evaluation II score.
Main Results:
- 2.1% of patients (296/13,862) died within 30 days.
- For isolated coronary-artery bypass grafting or aortic-valve surgery, a hs-cTnI level of 5670 ng/L (218x upper reference limit) was associated with increased 30-day mortality.
- For other cardiac surgeries, the threshold was 12,981 ng/L (499x upper reference limit).
Conclusions:
- Post-cardiac surgery hs-cTnI levels associated with increased 30-day mortality are substantially higher than current thresholds for defining myocardial injury.
- Existing recommendations for perioperative myocardial injury may need revision based on these findings.
More Related Videos
10:03Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
Related Concept Videos
Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
Acute Coronary Syndrome III: Diagnostic Studies
Acute Coronary Syndrome I: Introduction
Cardiomyopathy VII: Pre and Post Operative Nursing Management
Cardiac Catheterization IV: Nursing Management
Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
