Postoperative Delta Troponin I as a Predictor of 30-Day Major Adverse Cardiovascular Events after Coronary Artery Bypass Grafting: A Retrospective Cohort Study from an Indonesian Tertiary Referral Centre

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary artery disease undergoing elective coronary artery bypass grafting (CABG) (n=60). Intervention: Postoperative troponin I / Delta troponin I elevation vs. Lower postoperative / Delta troponin I levels (or No MACE group). Primary outcome: 30-day major adverse cardiovascular events (MACE: composite of malignant arrhythmia, acute heart failure, stroke, type 5 myocardial infarction, and cardiovascular death) (OR 1.231 per ng/mL, 95% CI 1.087-1.395, p=0.001).

Q: What does this research mean for the field?

Postoperative troponin I and delta troponin I independently predict and provide moderate discrimination for 30-day major adverse cardiovascular events after elective coronary artery bypass grafting. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Cici Irawanti Putri; Abdul Halim Raynaldo; Andika Sitepu

doi:10.71197/jsocmed.v5i10.324

October 31, 2026Journal of Society MedicineOpen Access

Postoperative Delta Troponin I as a Predictor of 30-Day Major Adverse Cardiovascular Events after Coronary Artery Bypass Grafting: A Retrospective Cohort Study from an Indonesian Tertiary Referral Centre

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Key result

Postoperative troponin I linked to ~23% higher 30-day major cardiovascular events risk per ng/mL after elective CABG.

OR 1.231 per ng/mL
95% CI 1.087-1.395
P=0.001
n=60

Why the study?

Although myocardial injury is almost universal after CABG, the prognostic significance of the postoperative rise in cardiac troponin I for 30-day MACE remains uncertain, particularly in Southeast Asian populations.

Does postoperative delta troponin I predict 30-day major adverse cardiovascular events in patients with coronary artery disease undergoing elective coronary artery bypass grafting?

Study Design

Type

Cohort (n=60)

Multicenter

No

Structured PICO

Does postoperative delta troponin I predict 30-day major adverse cardiovascular events in patients with coronary artery disease undergoing elective coronary artery bypass grafting?

P

Population

60 patients (mean age 59.7 years, 28.3% female) with coronary artery disease undergoing elective CABG without severe renal dysfunction or active infection, followed for 30 days.

E

Exposure

Postoperative delta (Δ) troponin I (defined as postoperative troponin I measured within 72 hours after surgery minus preoperative troponin I measured within 24 hours before surgery) and absolute postoperative troponin I measurement

O

Outcome

30-day major adverse cardiovascular events (MACE), a composite of malignant arrhythmia (ventricular tachycardia, ventricular fibrillation, or arrhythmia requiring resuscitation/immediate intervention), acute heart failure (requiring IV therapy, ventilatory support, or intensive care), stroke (neurological deficit ≥24 hours), type 5 myocardial infarction (Fourth Universal Definition), and cardiovascular death within 30 days after CABGcomposite

Main Result

Odds Ratio: 1.231 (95% CI 1.087–1.395)

p-value: p=0.001

Postoperative delta troponin I (cut-off 2.225 ng/mL) and absolute postoperative troponin I demonstrate moderate discrimination for predicting 30-day MACE—particularly cardiovascular death and type 5 MI—following elective CABG in an Indonesian cohort.

Limitations

Single-centre retrospective design and modest sample size (n=60) limit generalizability and precision
Multivariable model could not be adjusted for established clinical predictors (e.g., age, sex, EuroSCORE II, surgical technique) due to limited event numbers (36 events) and risk of overfitting
Troponin sampling was not standardized (any value within 72 hours postoperatively), potentially missing peak concentrations
Assay upper reportable limit of 15.0 ng/mL produced a ceiling effect
Inclusion of type 5 myocardial infarction (partly defined by troponin) in the composite MACE endpoint introduces incorporation bias
Optimal cut-off values were derived and evaluated in the same dataset without external validation
Stable patients undergoing elective surgery had near-undetectable baseline troponin, which limited variability and statistical power for evaluating preoperative troponin

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Implication

Postoperative troponin I may aid 30-day MACE risk stratification after CABG; leaves open validation of delta thresholds in prospective cohorts.

Abstract

Introduction: Myocardial injury is almost universal after coronary artery bypass grafting (CABG), yet the prognostic significance of the postoperative rise in cardiac troponin I remains uncertain, particularly in Southeast Asian populations. To evaluate the association and prognostic performance of postoperative delta (Δ) troponin I for 30-day major adverse cardiovascular events (MACE) after elective CABG. Methods: This retrospective cohort study enrolled 60 consecutive patients who underwent elective CABG at Haji Adam Malik General Hospital, Medan, Indonesia, between January 2025 and May 2026. Δ troponin I was calculated as postoperative (≤72 h) minus preoperative (≤24 h) troponin I. MACE comprised malignant arrhythmia, acute heart failure, stroke, type 5 myocardial infarction, and cardiovascular death within 30 days. Analyses included Mann–Whitney tests, multivariable logistic regression, and receiver operating characteristic (ROC) curves. Results: The mean age was 59.7 ± 7.5 years, and 71.7% were men. MACE occurred in 36 patients (60.0%). Median Δ troponin I was higher in patients with MACE than in those without (7.45 vs. 0.81 ng/mL; p = 0.002). Δ troponin I yielded an area under the curve of 0.742 (95% CI 0.610–0.875); a cut-off of 2.225 ng/mL provided 77.8% sensitivity, 79.2% specificity, and positive and negative predictive values of 84.8% and 70.4%, respectively. Postoperative troponin I independently predicted MACE (odds ratio 1.231 per ng/mL; 95% CI 1.087–1.395; p = 0.001). Conclusion: Postoperative Δ troponin I showed moderate discrimination for 30-day MACE after elective CABG and may complement early postoperative risk stratification pending external validation in larger prospective cohorts.

Discussion

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Cite This Study

Putri et al. (2026) conducted a cohort in Coronary artery disease undergoing elective coronary artery bypass grafting (CABG) (n=60). Postoperative troponin I / Delta troponin I elevation vs. Lower postoperative / Delta troponin I levels (or No MACE group) was evaluated on 30-day major adverse cardiovascular events (MACE: composite of malignant arrhythmia, acute heart failure, stroke, type 5 myocardial infarction, and cardiovascular death) (OR 1.231 per ng/mL, 95% CI 1.087-1.395, p=0.001). Postoperative troponin I independently predicted 30-day major cardiovascular events after elective CABG, while delta troponin I showed moderate discrimination.

synapsesocial.com/papers/6ae92596a8a6b2adf62f6055 https://doi.org/10.71197/jsocmed.v5i10.324

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Postoperative Delta Troponin I as a Predictor of 30-Day Major Adverse Cardiovascular Events after Coronary Artery Bypass Grafting: A Retrospective Cohort Study from an Indonesian Tertiary Referral Centre

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Postoperative Delta Troponin I as a Predictor of 30-Day Major Adverse Cardiovascular Events after Coronary Artery Bypass Grafting: A Retrospective Cohort Study from an Indonesian Tertiary Referral Centre

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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