Journal of Cardiothoracic Surgery (Nov 2022)

Prognostic value of high-sensitivity cardiac troponin I early after coronary artery bypass graft surgery

  • Samuele Nanni,
  • Mattia Garofalo,
  • Matteo Schinzari,
  • Elena Nardi,
  • Franco Semprini,
  • Paola Battistini,
  • Francesco Barberini,
  • Alberto Foà,
  • Massimo Baiocchi,
  • Andrea Castelli,
  • Gianluca Folesani,
  • Davide Pacini,
  • Nazzareno Galiè,
  • Anna Corsini

DOI
https://doi.org/10.1186/s13019-022-02027-x
Journal volume & issue
Vol. 17, no. 1
pp. 1 – 11

Abstract

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Abstract Background The diagnosis of periprocedural myocardial infarction (PMI) after coronary artery bypass graft (CABG) is based on biochemical markers along with clinical and instrumental findings. However, there is not a clear cutoff value of high-sensitivity cardiac troponin (hs-cTn) to identify PMI. We hypothesized that isolated hs-cTn concentrations in the first 24 h following CABG could predict cardiac adverse events (in-hospital death and PMI) and/or left ventricular ejection fraction (LVEF) decrease. Methods We retrospectively enrolled all consecutive adult patients undergoing CABG, alone or in association with other cardiac surgery procedures, over 1 year. Hs-cTn I concentrations (Access, Beckman Coulter) were serially measured in the post-operative period and analyzed according to post-operative outcomes. Results 300 patients were enrolled; 71.3% underwent CABG alone, 33.7% for acute coronary syndrome. Most patients showed hs-cTn I values superior to the limit required by the latest guidelines for the diagnosis of PMI. Five patients (1.7%) died, 8% developed a PMI, 10.6% showed a LVEF decrease ≥ 10%. Hs-cTn I concentrations did not significantly differ with respect to death and/or PMI whereas they were associated with LVEF decrease ≥ 10% (p value < 0.005 at any time interval), in particular hs-cTn I values at 9–12 h post-operatively. A hs-cTn I cutoff of 5556 ng/L, a value 281 (for males) and 479 (for females) times higher than the URL, at 9–12 h post-operatively was identified, representing the best balance between sensitivity (55%) and specificity (79%) in predicting LVEF decrease ≥ 10%. Conclusions Hs-cTn I at 9–12 h post-CABG may be useful to early identify patients at risk for LVEF decrease and to guide early investigation and management of possible post-operative complications.

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