Markedly elevated high-sensitivity troponin and in-hospital mortality after cardiac surgery
Pavan Reddy1, Matteo Cellamare1, Ilan Merdler1
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Insights
Markedly elevated high-sensitivity troponin (hsTnI) after cardiac surgery is linked to increased in-hospital death risk. This finding can help guide immediate post-operative patient management.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomarkers
Background:
- High-sensitivity troponin (hsTnI) is a known cardiac mortality predictor.
- Limited data exists on markedly elevated hsTnI and in-hospital mortality post-cardiac surgery.
- Understanding this relationship can optimize acute post-surgical management.
Purpose of the Study:
- To define the relationship between markedly elevated hsTnI and in-hospital mortality after cardiac surgery.
- To identify hsTnI as a potential risk stratification tool in the immediate post-operative period.
Main Methods:
- Retrospective analysis of cardiac surgeries from January 2020 to June 2022.
- Inclusion criteria: peak hsTnI >35x the upper limit of normal (ULN=34 ng/L).
- Primary outcome: in-hospital mortality. Subgroup analysis for CABG vs. other cardiac surgeries.
Main Results:
- 1382 cases analyzed; mean age 64.8 years, 68.2% male.
- Median peak hsTnI was 4202 ng/L.
- Each 1000 ng/L hsTnI increase correlated with a 3.8% rise in in-hospital death odds (OR 1.038, p<0.0001).
- Multivariate analysis confirmed hsTnI's significant association with mortality (OR 1.02, p=0.004).
- CABG showed lower mortality risk than other surgeries at hsTnI levels up to 60,000 ng/L.
Conclusions:
- Increasing hsTnI levels are significantly associated with a higher probability of in-hospital mortality.
- Elevated hsTnI serves as an objective risk indicator for guiding in-hospital clinical management.
- hsTnI can aid in timely intervention and resource allocation for high-risk post-cardiac surgery patients.
Background:
High-sensitivity troponin (hsTnI) is correlated with cardiac mortality; however, studies on the relationship of markedly elevated hsTnI with in-hospital mortality after cardiac surgery are sparse. Therefore, we aimed to define this relationship in order to help guide in-hospital, acute management of post-surgical patients.
Methods:
We retrospectively analyzed all cardiac surgeries completed at our institution between January 2020 and June 2022 in which a peak hsTnI was noted to be >35× upper limit of normal (ULN = 34 ng/L). The primary outcome was in-hospital death. Subgroup analysis was performed to assess differences between coronary artery bypass grafting (CABG) and other cardiac surgeries.
Results:
A total of 1382 cases met inclusion criteria. The patients' mean age was 64.8 years and 68.2 % were male. Median peak hsTnI after surgery was 4202 ng/L (interquartile ratio: 2427-7654). Univariate analysis of troponin level with mortality found that for every 1000 ng/L increase in hsTnI, odds of in-hospital death increased by 3.8 % (odds ratio [OR]: 1.038; 95 % confidence interval [CI] 1.027-1.050; p < 0.0001). In a multivariate model, troponin (OR 1.02; 95 % CI 1.01-1.04; p = 0.004) maintained a significant association with in-hospital death. CABG was associated with a lower risk of in-hospital death for any given hsTnI level up to 60,000 ng/L compared to other cardiac surgeries.
Conclusion:
Increasing hsTnI level is associated with increasing probability of in-hospital mortality and, therefore, serves as an additional, objective measure of risk to help guide in-hospital clinical management.
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