Sex-Specific Troponin and Creatine Kinase Thresholds After Coronary Bypass Surgery
Leo Pölzl1, Matthias Thielmann2, Philipp Sterzinger3
1Department of Cardiac Surgery, Medical University of Innsbruck, Austria.
Insights
Sex-specific differences in cardiac biomarker release after coronary artery bypass grafting (CABG) impact patient outcomes. Developing sex-specific thresholds for cardiac troponin (cTn) and creatine kinase-myocardial band (CK-MB) is crucial for accurate diagnosis and improved care.
Area of Science:
- Cardiology
- Biomarker Research
- Sex Differences in Medicine
Background:
- The impact of sex on cardiac biomarker release post-coronary artery bypass grafting (CABG) is not well understood.
- Cardiac biomarkers like high-sensitivity cardiac troponin (hs-cTn) and creatine kinase-myocardial band (CK-MB) are critical for assessing myocardial injury.
Purpose of the Study:
- To investigate sex differences in cardiac biomarker release following CABG.
- To establish sex-specific thresholds for hs-cTn and CK-MB to predict 30-day major adverse cardiovascular events (MACE) and mortality.
Main Methods:
- Analysis of a cohort of 3687 patients (643 women, 3044 men) undergoing CABG between 2008 and 2021.
- Serial postoperative measurements of hs-cTn and CK-MB.
- Determination of sex-specific thresholds for biomarkers associated with 30-day MACE and mortality.
Main Results:
- Women exhibited lower hs-cTn release post-CABG compared to men (69.18 vs. 77.57 times the upper reference limit).
- Optimal hs-cTn thresholds for predicting 30-day MACE were 94.36 times the URL for women and 206.07 times the URL for men.
- Female patients assessed with a general threshold showed increased risk for MACE and death within 30 days.
Conclusions:
- Significant sex-specific differences exist in cardiac biomarker release and outcomes after CABG.
- Sex-specific cutoffs for cardiac biomarkers are essential for accurate diagnosis of perioperative myocardial injury.
- Implementing sex-specific thresholds can improve outcomes for women undergoing CABG.
Background:
The impact of sex-differences on the release of cardiac biomarkers after coronary artery bypass grafting (CABG) remains unknown. The aim of our study was to (1) investigate the impact of sex-differences in cardiac biomarker release after CABG and (2) determine sex-specific thresholds for high-sensitivity cardiac troponin (hs-cTn) and creatine kinase-myocardial band (CK-MB) associated with 30-day major adverse cardiovascular events (MACE) and mortality.
Methods:
A consecutive cohort of 3687 patients, comprising 643 women (17.4%) and 3044 men (82.6%), undergoing CABG from 2008 to 2021 in 2 tertiary university centers with serial postoperative cTn and CK-MB measurement was analyzed. The composite primary outcome was MACE at 30 days. Secondary end points were 30-day mortality and 5-year mortality and MACE. Sex-specific thresholds for cTn and CK-MB were determined.
Results:
Lower levels of cTn were found in women after CABG (69.18 vs 77.57 times the upper reference limit [URL]; P < .001). The optimal threshold value for cTn was calculated at 94.36 times the URL for female patients and 206.07 times the URL for male patients to predict 30-day MACE. Female patients missed by a general threshold had increased risk for MACE or death within 30 days (cTn: MACE: odds ratio [OR], 3.78; 95% CI, 1.03-13.08; P = .035; death: OR, 4.98; 95% CI, 1.20-20.61; P = .027; CK-MB: MACE: OR, 10.04; 95% CI, 2.07-48.75; P < .001; death: OR 13.59; 95% CI, 2.66-69.47; P = .002).
Conclusions:
We provide evidence for sex-specific differences in the outcome and biomarker release after CABG. Sex-specific cutoffs are necessary for the diagnosis of perioperative myocardial injury to improve outcomes of women after CABG.
More Related Videos
10:12A Sensitive and Specific Quantitation Method for Determination of Serum Cardiac Myosin Binding Protein-C by Electrochemiluminescence Immunoassay
Published on: August 8, 2013
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Related Concept Videos
01:20Blood 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...
01:19Blood 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...