Key result
Post-operative troponin increase is linked to in-hospital mortality, with ~99% reaching the 10N threshold.
Why the study?
Troponin is used as a prognostic biomarker after cardiac surgery, but confounding biomarkers and varying myocardial infarction definition thresholds require confirmation of its independent predictive accuracy.
Does postoperative troponin elevation independently predict in-hospital mortality in patients undergoing cardiopulmonary bypass cardiac surgery?
Cohort (n=3,857)
Does postoperative troponin elevation independently predict in-hospital mortality in patients undergoing cardiopulmonary bypass cardiac surgery?
Troponin elevation independently predicts mortality after cardiac surgery, but the 10x upper normal limit threshold is reached in nearly all patients, questioning its utility for defining postoperative myocardial infarction.
Answers are grounded in this paper and cite their sources.
Questions the 10N troponin threshold for defining perioperative MI; leaves open its added value for risk stratification after cardiac surgery.
Objective Cardiac troponin is used as a prognostic biomarker after cardiac surgery. However, numerous confounding elements, such as inflammation, liver and renal function biomarkers, have been associated with troponin variations. Furthermore, several thresholds regarding the definition of myocardial infarction have been suggested. We aimed to confirm the accuracy of troponin, analysed as time-dependent variable, to predict mortality independently from other biomarkers; and to assess the incidence and prognosis of a 10 times upper normal value threshold (troponin 10N ) used in the current fourth definition of myocardial infarction. Methods In a prospective cohort of patients who underwent cardiopulmonary bypass cardiac procedures, we assessed the association between serum levels of troponin, creatinine, bilirubin, serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), C-reactive protein (CRP), lactate and in-hospital mortality. Several models were tested, including time-dependent Cox regression, survival and latent class analyses. Repetitive measurements were accounted for. Results We included 3857 patients. In-hospital mortality was 2.8%. Troponin was independently associated with mortality in all models, after adjusting for other biomarkers. Of note, troponin 10N was reached in 3830/3857 (99.3%) of patients. Similarly, renal function was independently associated with mortality. Conversely, CRP and liver biomarkers were not associated with mortality, once adjusting for other confounders. Conclusion We confirmed that troponin increase was independently associated with mortality after cardiac surgery. This association was independent of inflammatory syndrome and renal and liver failure. Troponin 10N was reached in almost all patients, questioning the relevance of this criterion to define postoperative myocardial infarctions after cardiac surgery.
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Clément et al. (2022) conducted a cohort in Cardiac surgery with cardiopulmonary bypass (n=3,857). Troponin elevation was evaluated on In-hospital mortality. Troponin increase was independently associated with in-hospital mortality after cardiac surgery, and the troponin 10N threshold was reached in 99.3% of patients.
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