Abstract
IntroductionThe objective of the present study was to compare postoperative cardiac troponin I (cTnI) release and the thresholds of cTnI that predict adverse outcome after elective coronary artery bypass graft (CABG), after valve surgery, and after combined cardiac surgery.MethodsSix hundred and seventy-five adult patients undergoing conventional cardiac surgery with cardiopulmonary bypass were retrospectively analyzed. Patients in the CABG (n = 225) and valve surgery groups (n = 225) were selected after matching (age, sex) with those in the combined surgery group (n = 225). cTnI was measured preoperatively and 24 hours after the end of surgery. The main endpoint was a severe postoperative cardiac event (sustained ventricular arrhythmias requiring treatment, need for inotropic support or intraaortic balloon pump for at least 24 hours, postoperative myocardial infarction) and/or death. Data are presented as the median and the odds ratio (95% confidence interval).ResultsPostoperative cTnI levels were significantly different among the three groups (combined surgery, 11.0 (9.5–13.1) ng/ml versus CABG, 5.2 (4.7–5.7) ng/ml and valve surgery, 7.8 (7.6–8.0) ng/ml; P < 0.05). The thresholds of cTnI predicting severe cardiac event and/or death were also significantly different among the three groups (combined surgery, 11.8 (11.5–14.8) ng/ml versus CABG, 7.8 (6.7–8.8) ng/ml and valve surgery, 9.3 (8.0–14.0) ng/ml; P < 0.05). An elevated cTnI above the threshold in each group was significantly associated with a severe cardiac event and/or death (odds ratio, 4.33 (2.82–6.64)).ConclusionThe magnitude of postoperative cTnI release is related to the type of cardiac surgical procedure. Different thresholds of cTnI must be considered according to the procedure type to predict early an adverse postoperative outcome.
Highlights
The objective of the present study was to compare postoperative cardiac troponin I release and the thresholds of cTnI that predict adverse outcome after elective coronary artery bypass graft (CABG), after valve surgery, and after combined cardiac surgery
Different thresholds of cTnI must be considered according to the procedure type to predict early an adverse postoperative outcome
Our study demonstrates that postoperative cTnI release in conventional adult cardiac surgery with cardiopulmonary bypass (CPB) depends on the type of surgery, even in the absence of an adverse postoperative outcome; that different thresholds of cTnI according to the procedure type should be considered to predict a poor outcome; and that the accuracy of cTnI to predict a poor outcome may be different among procedure types
Summary
The objective of the present study was to compare postoperative cardiac troponin I (cTnI) release and the thresholds of cTnI that predict adverse outcome after elective coronary artery bypass graft (CABG), after valve surgery, and after combined cardiac surgery. CPB is associated with a certain degree of myocardial damage, and its CABG = coronary artery bypass grafting; CI = confidence interval; CPB = cardiopulmonary bypass; cTnI = cardiac troponin I; ICU = cardiac intensive care unit; ROC = receiver operating characteristics. Duration is likely to influence the postoperative cTnI release [9] This increase could depend on the type of surgery and its subsequent degree of direct surgical trauma [9,10]. Valve replacement may induce more direct surgical trauma than coronary artery bypass graft (CABG) surgery, whereas combined surgery is associated with a more prolonged CPB time
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