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Updated: Sep 27, 2026
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Using CK-MB and hs-cTnT to Predict 30-Day Mortality After CABG: A Combined Biomarker Risk-Stratification Approach
Winter-Pölzl Leo1, Kletzer Joseph2, Lohmann Ronja1
1Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Background:
Accurate diagnosis of perioperative myocardial infarction after coronary artery bypass grafting remains challenging due to uncertainty over postoperative cardiac biomarker interpretation.
Objectives:
The authors aimed to evaluate the prognostic value and performance of postoperative creatine kinase-myocardial band (CK-MB) and high-sensitivity cardiac troponin T (hs-cTnT) and explore a combined approach to identify patients at risk of early death.
Methods:
This multicenter cohort study involved 9,856 patients undergoing isolated coronary artery bypass grafting at hospitals in Innsbruck, Freiburg, Gothenburg, and Reykjavik. A combined biomarker matrix was created to assess synergistic effects. Associations of biomarkers with 30-day all-cause mortality were evaluated using multivariable Cox regression (adjusted HR) and area under the receiver-operating curve (AUC) analysis.
Results:
Thirty-day all-cause mortality was 2.0%. Median peak values within 72 hours postsurgery were 2.24 (Q1-Q3: 1.66-3.36) × upper reference limit for CK-MB and 52.06 (Q1-Q3: 29.79-90.00) × upper reference limit for hs-cTnT. Both postoperative CK-MB (adjusted HR: 1.95; 95% CI: 1.79-2.12; P < 0.001) and hs-cTnT (adjusted HR: 1.71; 95% CI: 1.61-1.82; P < 0.001) were associated with higher mortality risk per doubling in concentration independent of EuroSCORE II. Predictive accuracy of CK-MB and hs-cTnT was similar (AUC: 0.787 vs 0.784; P = 0.99), yet stratification using Youden-derived thresholds identified distinct patient subgroups with limited overlap. In a combined analysis, mortality risk was increased only when CK-MB was in the top tertile and hs-cTnT in the mid (adjusted HR: 4.34; 95% CI: 1.78-10.62; P < 0.001) or top tertile (adjusted HR: 14.78; 95% CI: 6.85-31.88; P < 0.001).
Conclusions:
The combined use of CK-MB and hs-cTnT enables a simple and robust risk-stratification strategy for early postoperative mortality, with direct implications for clinical surveillance and future cardiac surgery trials.
