Why the study?
Although peak postoperative cTnT predicts outcomes after cardiac surgery, studies have reported two peaks over the first 48 to 72 hours; this study aimed to understand the underlying reasons and clinical consequences of this profile.
Does delayed post-operative cardiac troponin T elevation predict worse clinical outcomes compared to early elevation in adult patients undergoing cardiac surgery?
Does delayed post-operative cardiac troponin T elevation predict worse clinical outcomes compared to early elevation in adult patients undergoing cardiac surgery?
A delayed increase in cardiac troponin T following cardiac surgery is of higher clinical relevance than a prompt elevation, as it is associated with significantly higher rates of post-operative complications and mortality.
Answers are grounded in this paper and cite their sources.
Late cTnT peaks were associated with higher complication rates after cardiac surgery; leaves open whether timed serial monitoring refines risk stratification.
Background: Peak postoperative cardiac troponin T (cTnT) independently predicts mid- and long-term outcome of cardiac surgery patients. A few studies however reported 2 peaks of cTnT over the first 48-72 hours following myocardial reperfusion. The aim of the current study was to better understand underlying reasons of this cTnT profile and possible consequences on clinical outcome. Methods: All consecutive adult cardiac surgical procedures performed with an extra-corporeal circulation during a >6 years period were retrospectively evaluated. Patients with a myocardial infarction (MI) 6 to ≤12 hours (n=366), >12 to ≤18 hours (n=176), >18 to ≤24 hours (171), >24 hours (218). Age (OR: 1.023; CI:1.016-1.030) and isolated CABG (OR: 1.779; CI: 1.114-2.839) were independent predictors of a late increase of cTnT over a limit of 1 ng/ml (p<0.05), whereas isolated valve procedures (OR:0.685; CI: 0.471-0.998) and cross-clamp duration (OR: 0.993; CI: 0.990-0.997) independently predicted an early elevation (p<0.05). Delayed elevation over 1 ng/ml correlated with a higher rate of post-operative complications including MI (19.8% vs. 7.2%), new renal insufficiency (16.3% vs. 6.7%), MACCE (32.0% vs. 15.5%) or death (7.4% vs. 4.4%). Conclusion: Profile of cTnT elevation following cardiac surgery depends on patients’ intrinsic factors, type of surgery and duration of cross-clamp time. Delayed increase is of higher clinically relevance than prompt post-operative elevation.
No takes yet. Share an insight, caveat, or question.
Stahel et al. (2018) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: