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Prognostic Implications of Preoperative hs-cTnT in Elective Coronary Artery Bypass Grafting
Leo Pölzl1, Joseph Kletzer2, Ronja Lohmann1
1Department of Cardiac Surgery, Medical University of Innsbruck, Tyrol, Innsbruck, Austria.
Insights
Preoperative high-sensitivity troponin T (hs-cTnT) elevation predicts adverse outcomes in elective coronary artery bypass grafting (CABG). Elevated hs-cTnT identifies high-risk patients, guiding treatment decisions and improving clinical results.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomarkers
Background:
- Elevated preoperative high-sensitivity troponin T (hs-cTnT) may indicate myocardial vulnerability in patients undergoing elective coronary artery bypass grafting (CABG).
- This vulnerability can influence surgical timing and perioperative management strategies.
Purpose of the Study:
- To investigate the association between preoperative hs-cTnT levels and perioperative outcomes.
- To evaluate the link between hs-cTnT levels and both short-term and long-term mortality.
- To enhance risk stratification and clinical decision-making for elective CABG patients.
Main Methods:
- A retrospective analysis of 5,450 patients undergoing elective CABG between 2010 and 2023.
- Patients were stratified into three groups based on preoperative hs-cTnT levels: nonelevated (<1x URL), mildly elevated (1-3x URL), and significantly elevated (>3x URL).
- Propensity score weighting was used to assess the association of hs-cTnT with perioperative outcomes and mortality (30-day and 5-year).
Main Results:
- 26.6% of patients had hs-cTnT >1x URL, and 12.4% had levels >3x URL.
- Significantly elevated hs-cTnT (>3x URL) was associated with increased risks of ECMO use (HR: 2.96), hemofiltration (HR: 2.99), and 5-year mortality (HR: 1.55) (all P < 0.001).
- Mild hs-cTnT elevations (1-3x URL) were also linked to higher rates of hemofiltration (HR: 2.25), ECMO use (HR: 1.65), and 5-year mortality (HR: 1.37) (all P < 0.05).
Conclusions:
- Preoperative hs-cTnT is an independent predictor of adverse outcomes in elective CABG.
- Routine preoperative hs-cTnT assessment can identify high-risk individuals.
- Integrating hs-cTnT may optimize surgical timing and guide treatment choices (CABG vs. PCI), improving patient outcomes.
Background:
Elevated preoperative hs-cTnT may reflect underlying myocardial vulnerability, potentially influencing surgical timing and perioperative strategies in patients undergoing elective coronary artery bypass grafting (CABG).
Objectives:
This study investigates the association between preoperative hs-cTnT levels, perioperative outcomes, and long-term mortality, aiming to improve risk stratification and guide clinical decision-making.
Methods:
This retrospective study analyzed a consecutive series of 5,450 patients undergoing CABG at 2 tertiary centers between 2010 and 2023. Patients were categorized into 3 groups based on preoperative hs-cTnT levels: 1) nonelevated (<1x upper reference limit [URL]); 2) mildly elevated (1-3x URL); and 3) significantly elevated (>3x URL). A propensity score weighting method was performed before evaluating the association of hs-cTnT with perioperative outcomes, 30-day mortality and 5-year mortality.
Results:
Among elective CABG patients, 26.6% had hs-cTnT levels >1x URL, and 12.4% had levels >3x URL. Patients with significantly elevated hs-cTnT (>3x URL) demonstrated increased risks of extracorporeal membrane oxygenation use (HR: 2.96 [95% CI: 1.81-4.84]), hemofiltration (HR: 2.99 [95% CI: 2.27-3.94]), and 5-year mortality (HR: 1.55 [95% CI: 1.28-1.86]) (all P < 0.001). Even mild elevations (1-3x URL) were linked to higher rates of hemofiltration (HR: 2.25 [1.75-2.90]; P < 0.001), extracorporeal membrane oxygenation use (HR: 1.65 [95% CI: 1.01-2.69]; P = 0.046), and 5-year mortality (HR: 1.37 [95% CI: 1.14-1.34]; P < 0.001).
Conclusions:
Preoperative hs-cTnT is an independent predictor of adverse outcomes in elective CABG. Integrating hs-cTnT into routine preoperative assessment could identify high-risk patients, optimize surgical timing, and determine whether patients may benefit more from CABG or percutaneous coronary intervention, ultimately improving clinical outcomes.
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