Meta-Analysis Evaluating High-Sensitivity Cardiac Troponin T Kinetics after Coronary Artery Bypass Grafting in Relation to the Current Definitions of Myocardial Infarction

Samuel Heuts,Ellen J.S Denessen,Jean H.T Daemen,Wim H.M Vroemen,Jan-Willem Sels,Patrique Segers,Otto Bekers,Arnoud W.J Van ‘T Hof,Jos G Maessen,Iwan C.C Van Der Horst,Alma M.A Mingels

doi:10.1016/j.amjcard.2021.09.049

Abstract

Various definitions of myocardial infarction type 5 after coronary artery bypass grafting (CABG) have been proposed (myocardial infarction [MI-5], also known as peri-procedural MI), using different biomarkers and different and arbitrary cut-off values. This meta-analysis aims to determine the expected release of high-sensitivity cardiac troponin T (hs-cTnT) after CABG in general and after uncomplicated surgery and off-pump CABG in particular. A systematic search was applied to 3 databases. Studies on CABG as a single intervention and reporting on postoperative hs-cTnT concentrations on at least 2 different time points were included. All data on hs-cTnT concentrations were extracted, and mean concentrations at various points in time were stratified. Eventually, 15 studies were included, encompassing 2,646 patients. Preoperative hs-cTnT was 17 ng/L (95% confidence interval [CI] 13 to 20 ng/L). Hs-cTnT peaked at 6 to 8 hours postoperatively (628 ng/L, 95% CI 400 to 856 ng/L; 45x upper reference limit [URL]) and was still increased after 48 hours. In addition, peak hs-cTnT concentration was 614 ng/L (95% CI 282 to 947 ng/L) in patients with a definite uncomplicated postoperative course (i.e., without MI). For patients after off-pump CABG compared to on-pump CABG, the mean peak hs-cTnT concentration was 186 ng/L (95% CI 172 to 200 ng/L, 13×URL) versus 629 ng/L (95% CI 529 to 726 ng/L, 45×URL), respectively. In conclusion, postoperative hs-cTnT concentrations surpass most of the currently defined cut-off values for MI-5, even in perceived uncomplicated surgery, suggesting thorough reassessment. Hs-cTnT release differences following on-pump CABG versus off-pump CABG were observed, implying the need for different cut-off values for different surgical strategies.

Highlights

The upper reference limit (URL) is required for the diagnosis of MI-5, in conjunction with imaging or electrocardiographic evidence
Studies enrolling patients treated with on-pump coronary artery bypass grafting (CABG) or off-pump CABG (OPCAB) and reporting on postoperative high-sensitivity cardiac troponin T (hs-cTnT) concentrations were included
Post-hoc subgroup analyses were performed for studies reporting separately on hs-cTnT concentrations after on-pump CABG and OPCAB

Summary

Grafting in Relation to the Current Definitions of Myocardial Infarction

It may be unlikely that the study design influences these values, we performed a risk of bias assessment using The Jadad Scale for Reporting Randomized Clinical Trials for randomized controlled trials, to determine study quality To homogeneously assess this quality in the different observational studies, it was imperative to use a tool that was able to assess single- and 2-armed studies in the same manner. Post-hoc subgroup analyses were performed for studies reporting separately on hs-cTnT concentrations after on-pump CABG and OPCAB. All studies were perceived to be of sufficient

Surgery Type

MI Incidence

Findings

Disclosures