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Elevated troponin I is associated with a worse long-term prognosis in patients undergoing beating-heart coronary

Kang Min Kim1, Sang Yoon Kim1, Joon Chul Jung1

  • 1Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|March 22, 2023
PubMed

Insights

Elevated troponin I levels after beating-heart coronary artery bypass grafting (CABG) predict worse long-term survival. Conventional CABG showed no such association, indicating technique-specific risk stratification is crucial for cardiac surgery outcomes.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Biomarkers

Background:

  • Coronary artery bypass grafting (CABG) is a common cardiac surgery procedure.
  • Troponin I is a biomarker for myocardial injury.
  • The prognostic value of elevated troponin I levels post-CABG requires further investigation.

Purpose of the Study:

  • To investigate the impact of elevated postoperative peak troponin I (ppTnI) levels on long-term outcomes after CABG.
  • To compare the prognostic significance of ppTnI between conventional CABG and beating-heart CABG techniques.

Main Methods:

  • A cohort of 996 patients undergoing elective isolated CABG for stable or unstable angina was analyzed.
  • Patients were stratified into higher and lower ppTnI groups based on the 80th percentile.
  • Long-term clinical outcomes, including 10-year overall survival, were assessed.

Main Results:

  • Median ppTnI was significantly higher in conventional CABG compared to beating-heart CABG (4.04 vs 1.24 ng/ml).
  • In beating-heart CABG, patients with ppTnI ≥ 3.3 ng/ml (80th percentile) had significantly worse 10-year survival (64% vs 73%).
  • Elevated ppTnI was identified as a risk factor for overall death in beating-heart CABG (HR: 1.505, P=0.040).

Conclusions:

  • Higher postoperative peak troponin I levels are associated with worse long-term survival specifically in patients undergoing beating-heart CABG.
  • This association was not observed in patients who underwent conventional CABG.
  • Risk stratification based on troponin levels may be technique-dependent in CABG surgery.
Abstract

Keywords:
Coronary artery bypassMyocardial revascularizationOff-pumpTroponin I

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