Key result
cTnT peak occurrence within 24 hours after off-pump coronary artery bypass grafting was associated with lower mid-term mortality (HR 0.356) compared to delayed peak occurrence.
Why the study?
There is no consensus on the specific values of myocardial injury biomarkers in evaluating postoperative prognosis after cardiac surgery.
Does a delayed peak of cardiac troponin T predict higher mid-term mortality in patients undergoing off-pump coronary artery bypass grafting?
Cohort (n=564)
No
Does a delayed peak of cardiac troponin T predict higher mid-term mortality in patients undergoing off-pump coronary artery bypass grafting?
Answers are grounded in this paper and cite their sources.
In patients undergoing off-pump CABG, the timing of the cTnT peak (specifically, a delayed peak after 24 hours) is a stronger independent predictor of mid-term mortality than the absolute peak value.
Background: With the development of cardiac surgery technology, myocardial injury is gradually reduced, but cannot be completely avoided. Myocardial injury biomarkers (MIBs) can quickly and specifically reflect the degree of myocardial injury. Due to various reasons, there is no consensus on the specific values of MIBs in evaluating postoperative prognosis. This retrospective study was aimed to investigate the impact of MIBs on the mid-term prognosis of patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods: Totally 564 patients undergoing OPCABG with normal courses were included. Cardiac troponin T (cTnT) and creatine kinase myocardial band (CK-MB) were assessed within 48 hours before operation and at 6, 12, 24, 48, 72, 96 and 120 hours after operation. Patients were grouped by peak values and peak time courses of MIBs. The profile of MIBs and clinical variables as well as their correlations with mid-term prognosis were analyzed by univariable and multivariable cox regression models. Result: Continuous assessment showed that MIBs increased first (12 hours after surgery) and then decreased. The peak cTnT and peak CK-MB occurred within 24 hours after operation in 76.8% and 67.7% of the patients respectively. No significant correlation was found between CK-MB and mid-term mortality. Delayed cTnT peak (peak cTnT elevated after 24 hours after operation) was correlated with lower Ccr (69.36±21.67 vs. 82.18±25.17 ml/min/1.73 m 2 ), body mass index (24.35±2.58 vs. 25.27±3.26 kg/m 2 ), less arterial grafts (1.24±0.77 vs. 1.45±0.86), higher Euroscore II (2.22±1.12 vs.1.72±0.91) and mid-term mortality (26.5 vs.7.9 %). Age (HR: 1.067, CI:1.005-1.132), left ventricular ejection fraction (HR: 0.950, CI:0.910-0.992), New York Heart Association score (HR: 1.833, CI:1.155-2.908), total venous grafting (HR: 2.833, CI:1.054-7.611) and cTnT peak occurrence within 24 hours (HR: 0.356, CI:0.731-2.513) were independent predictors of mid-term mortality. Conclusion: cTnT is a better indicator than CK-MB. The peak and peak occurrence of cTnT are related to mid-term mortality in patients undergoing OPCABG, and the peak phases have stronger predictive ability.
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Hu et al. (2021) conducted a cohort in Off-pump coronary artery bypass grafting (OPCABG) (n=564). cTnT peak occurrence within 24 hours vs. cTnT peak occurrence after 24 hours was evaluated on Mid-term mortality (HR 0.356, 95% CI 0.731-2.513, p=<0.001). cTnT peak occurrence within 24 hours after off-pump coronary artery bypass grafting was associated with lower mid-term mortality (HR 0.356) compared to delayed peak occurrence.
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