Key result
Elevations in conventional and high-sensitivity cardiac troponin T 6 to 12 hours after CABG were associated with increased odds of in-hospital MACCE (AUC 0.72 and 0.77, respectively).
Why the study?
Does early postoperative elevation of cTnT or hs-cTnT predict in-hospital MACCE in patients undergoing isolated CABG?
Cohort (n=1,722)
Does early postoperative elevation of cTnT or hs-cTnT predict in-hospital MACCE in patients undergoing isolated CABG?
Early postoperative measurement of cTnT or hs-cTnT (6-12 hours) after CABG provides clinically relevant prognostic information for predicting in-hospital MACCE and other complications.
Answers are grounded in this paper and cite their sources.
Troponin elevations 6-12 h post-CABG may aid in-hospital risk stratification; hypothesis-generating pending prospective validation.
BACKGROUND: Cardiac troponin T (cTnT) is elevated after coronary artery bypass grafting surgery. The aim of this study was to determine the association between cTnT elevations between 6 and 12 hours after coronary artery bypass grafting and in-hospital outcome. METHODS AND RESULTS: We prospectively studied 1722 patients undergoing isolated coronary artery bypass grafting. We assessed the association between conventional cTnT (749 patients) and high-sensitivity cTnT (hs-cTnT; 973 patients) 6 to 12 hours postoperatively with in-hospital major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, or stroke. The prespecified secondary outcome was a safety composite of MACCE, resuscitation, intensive care unit readmission or admission ≥48 hours, inotrope or vasopressor use ≥24 hours, or new-onset renal insufficiency. Among patients with a conventional cTnT measurement, 92 experienced a MACCE (12%) and 146 experienced a safety composite event (19%). Likewise, for hs-cTnT, 114 experienced a MACCE (12%) and 153 experienced a safety composite event (16%). Compared with cTnT ≤200 ng/L, each 200-ng/L increment in cTnT was associated with a monotonous increase in the odds of MACCE and the safety composite outcome. Conventional and hs-cTnT demonstrated moderate discrimination for MACCE (areas under the fitted receiver operating characteristics curve, 0.72 and 0.77 for conventional and hs-cTnT, respectively) and the safety composite outcome (areas under the fitted receiver operating characteristics curve, 0.66 and 0.74 for conventional and hs-cTnT, respectively) and resulted in improved prognostic performance when added to the EuroSCORE. At a cutoff of 800 ng/L, conventional and hs-cTnT provided clinically relevant power to rule in MACCE and the safety composite outcome. CONCLUSIONS: cTnT levels assessed between 6 and 12 hours after coronary artery bypass grafting identify patients at increased risk of MACCE or other complications.
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Gahl et al. (2018) conducted a cohort in Coronary artery bypass grafting (n=1,722). Cardiac troponin T (cTnT and hs-cTnT) elevation 6 to 12 hours postoperatively vs. cTnT ≤200 ng/L was evaluated on In-hospital major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, or stroke. Elevations in conventional and high-sensitivity cardiac troponin T 6 to 12 hours after CABG were associated with increased odds of in-hospital MACCE (AUC 0.72 and 0.77, respectively).
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