What question did this study set out to answer?

To characterize serial postoperative cardiac troponin I kinetics and determine optimal threshold values for ruling in or ruling out Type 5 myocardial infarction after elective coronary artery bypass grafting.

January 26, 2014Interactive Cardiovascular and Thoracic SurgeryOpen Access

Optimal cut-off value for cardiac troponin I in ruling out Type 5 myocardial infarction

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Why the study?

What is the optimal cut-off value for cardiac troponin I to rule out Type 5 myocardial infarction in patients undergoing elective coronary artery bypass grafting?

Population

99 patients with two- and three-vessel disease scheduled for elective on-pump coronary artery bypass grafting

Design

Cohort

Follow-up

72 hours postoperatively

Authors

MNMads NyboGeneral Cardiology MJMarianne Kjær JensenOdense University Hospital PMPoul Erik MortensenOdense University Hospital

Discussion

Member takes

Implication

May aid ruling out Type 5 MI after elective CABG; hypothesis-generating pending prospective validation.

Key Points

To characterize serial postoperative cardiac troponin I kinetics and determine optimal threshold values for ruling in or ruling out Type 5 myocardial infarction after elective coronary artery bypass grafting.
Evaluated 99 enrolled patients with two- and three-vessel disease undergoing elective on-pump coronary artery bypass grafting between 2011 and 2012.
Measured serial cardiac troponin I levels prior to surgery and at 0, 2, 4, 6, 12, 24, 48, and 72 hours postoperatively using an assay with an upper reference limit of 30 ng/l.
Diagnosed Type 5 myocardial infarction prospectively using clinical, electrocardiographic, imaging, and routine troponin data, blinded to serial study measurements.
Type 5 myocardial infarction was diagnosed in 8 of 99 patients (8%), with affected patients exhibiting higher median peak troponin I levels than unaffected patients (20,500 ng/l vs. 7,675 ng/l; P = 0.01).
Optimal cut-off values were determined to be 7,970 ng/l (266 times the upper reference limit) at 12 hours and 9,950 ng/l (331 times the upper reference limit) at 24 hours.
Both the 12-hour and 24-hour thresholds demonstrated a negative predictive value of 0.99, with positive predictive values of 0.23 at 12 hours and 0.35 at 24 hours.

Structured PICO

What is the optimal cut-off value for cardiac troponin I to rule out Type 5 myocardial infarction in patients undergoing elective coronary artery bypass grafting?

Population

99 patients with two- and three-vessel disease scheduled for elective on-pump coronary artery bypass grafting

Intervention

Serial cardiac troponin I (cTnI) measurements within 72 h postoperatively (before and 0, 2, 4, 6, 12, 24, 48 and 72 h after surgery)

Outcome

Optimal cardiac troponin I cut-off value in ruling in or ruling out a Type 5 MIsurrogate

In clinically stable patients undergoing elective CABG, specific cTnI cut-off values at 12 and 24 hours postoperatively have a high negative predictive value for ruling out Type 5 MI.

Cite This Study

Nybo et al. (2014) studied this question.

synapsesocial.com/papers/6a7cfb165562f9debf0eb48d https://doi.org/10.1093/icvts/ivt558

Topics

Coronary artery disease

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Optimal cut-off value for cardiac troponin I in ruling out Type 5 myocardial infarction

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Optimal cut-off value for cardiac troponin I in ruling out Type 5 myocardial infarction

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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