Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T

Area of Science:

• Cardiology
• Cardiac Surgery
• Biomarkers

Background:

• Defining peri-operative myocardial injury (PMI) using high-sensitivity troponin (hs-Tn) cut-offs after cardiac surgery remains challenging.
• Accurate identification of PMI is crucial for patient prognosis.

Purpose of the Study:

• To evaluate the association between peri-operative high-sensitivity troponin T (hs-TnT) elevations and 1-year all-cause mortality in cardiac surgery patients.
• To establish reliable hs-TnT cut-offs for prognostically significant PMI.

Main Methods:

• A post-hoc analysis of the ERICCA trial involving 1206 patients.
• Assessment of baseline and various post-operative hs-TnT thresholds (measured at 6, 12, 24, 48, and 72 hours) for 1-year all-cause mortality.
• Statistical adjustments for baseline hs-TnT and EuroSCORE.

Main Results:

• Baseline hs-TnT elevation >1x 99th percentile URL was linked to increased 1-year mortality (aHR 1.90).
• In patients with normal baseline hs-TnT, significant mortality risk was observed with post-operative elevations of ≥50 × URL at 24 hours.
• An hs-TnT elevation of ≥50 × URL at 24 hours demonstrated optimal sensitivity (73%) and specificity (75%) for predicting mortality.

Conclusions:

• Both baseline and post-operative hs-TnT elevations are independent predictors of 1-year all-cause mortality post-cardiac surgery.
• An hs-TnT elevation of ≥50 × URL at 24 hours post-surgery is proposed as the optimal threshold for defining prognostically significant PMI.