Abstract 12144: Prognostic Value of Preoperative Cardiac Troponin I and T in Patients With Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting: A Current Report of the North-Rhine-Westphalia Surgical Myocardial Infarction Registry

Abstract

Introduction: The extent of myocardial injury is a major determinant of morbidity and mortality in patients undergoing coronary artery bypass grafting (CABG) with acute coronary syndromes (ACS). More recently, cardiac biomarkers such as troponin I and T have been suggested as predictors for unfavorable outcome. We aimed to evaluate the predictive value of cardiac troponin (I and T) on a multicentric basis. Methods: We obtained multicentric data from a national surgical myocardial infarction registry with 2432 patients undergoing CABG with ACS between 01/2010 and 12/2018. Primary study endpoint was all-cause, in-hospital mortality (IHM) and postoperative major adverse cardiac and cerebrovascular events (MACCE). Multivariable logistic regression models and receiver-operating curve (ROC) analyses were applied to assess predictive value of preoperative cTnI and T for IHM and MACCE following CABG. Results: Patients were 68±11years of age, 78% male, 24.5% had unstable angina (UAP), 50.0% NSTEMI, and 25.4% STEMI, presenting a logEuroSCORE-I of 15.1±15.1% in UAP, 20.3±20.1% in NSTEMI and 23.5±20.0% in STEMI. Preoperative cTnI or T was obtained on admission and preoperatively with 5.4±19.5 and 3.6±10.0ng/mL for cTnI and 0.93±1.7 and 0.90±1.8ng/mL for cTnT. Preoperative cTnI and T was significantly increased between survivors and non-survivors (cTnI:4.2±11.9 vs. 22.4±59.5ng/mL, P <0.05 and cTnT:0.9±1.7 vs. 1.3±1.9ng/mL; P <0.05). STEMI patients demonstrated higher cardiac biomarker levels and worse IHM (12.6%) compared to NSTEMI (7.3%; P <0.01) and UAP patients (4.2%; P <0.01). Multivariable logistic regression analysis revealed cTnI but not cTnT to be a strong and independent predictor for IHM and MACCE ( P <0.001). Preoperative cTnI and T >2xURL showed a significant predictive value for IHM ( P <0.003) and MACCE ( P <0.001). In a ROC analysis, a cTnI value of 10.1ng/mL with an area under curve (AUC) of 0.65 ( P< 0.01) was identified as an optimal cut-off value for IHM and 6.8ng/mL with an AUC of 0.65 ( P <0.001) for MACCE. Conclusions: In this large-scaled national registry, we can confirm that preoperative cardiac troponin I but not T indicates important prognostic information of in-hospital mortality and MACCE rate in ACS patients undergoing CABG surgery.