Objective: Myocardial infarction (MI) associated with coronary artery bypass grafting (CABG) operations represents a serious and relatively frequent peri-operative complication. Markers of myocardial necrosis are usually found elevated in patients undergoing coronary bypass operation with cardiac arrest. Cardiac troponin I (cTnI) is the preferred marker to detect acute myocardial ischemia. Its ability to predict short and, particularly, midterm outcome following coronary bypass operations is uncertain. The aim of the presented study is to assess the role of postoperative cTnI in predicting in-hospital and mid-term outcome in non-selected patients undergoing CABG and to suggest a critical use of cTnI to improve post-operative care of patients with elevated troponin release. Methods: Between May 2000 and February 2003, 230 unselected patients undergoing surgical revascularization had cTnI measured preoperatively and 11 times postoperatively. Patients with unstable angina and recent MI (<7 days) were included in the study. Patients undergoing aortic dissection surgery and those undergoing heart valve procedures with associated CABG as well as patients transferred on emergency in the operative room following complicated percutaneous coronary intervention were excluded. A receiver operating characteristics (ROC) curve was constructed using cTnI postoperative peak values to assess prognostic specificity and sensitivity of the test. 13 ng/ml is the cut-off value used to assess the prognostic significance of peak cTnI postoperative release for short and mid-term outcome for mortality and hospitalization for cardiac causes. Mean and maximal follow-up were 22.6±10.7 and 48.3 months, completeness 90%. Results: 146 patients (63.5%) had postoperative cTnI peak values <13 ng/ml (mean peak value 6.6±3.1 ng/ml), 84 patients (36.5%) had postoperative cTnI peak values >13 ng/ml (mean peak value 45.5±59.9 ng/ml). Patients with peak cTnI >13 ng/ml were older, had lower body mass index and had higher preoperative cTnI values. They required longer cross-clamp time and CPB time. Post-operative results are shown. Hospital death was significantly higher in cTnI >13 ng/ml group (9.5% vs. 0.7%, P = 0.0009). = 0.0009). Multivariate analysis showed that cTnI >13 ng/ml was the only independent predictor of hospital death (OR 10.33, P = 0.04) and hospital death for = 0.04) and hospital death for cardiac causes. Two years follow-up demonstrate that cTnI postoperative release had no influence on mid-term mortality and hospitalization for cardiac causes.Conclusions: The presented is the largest study reporting mid-term survival for CABG patients based on postoperative cTnI release. CTnI is a valuable marker for immediate myocardial damage following coronary bypass operations. CTnI postoperative release does not predict mid-term outcome.
Cardiac Troponin I release following coronary artery bypass surgery. Effects on operative and mid-term survival
Galeone A;
2005-01-01
Abstract
Objective: Myocardial infarction (MI) associated with coronary artery bypass grafting (CABG) operations represents a serious and relatively frequent peri-operative complication. Markers of myocardial necrosis are usually found elevated in patients undergoing coronary bypass operation with cardiac arrest. Cardiac troponin I (cTnI) is the preferred marker to detect acute myocardial ischemia. Its ability to predict short and, particularly, midterm outcome following coronary bypass operations is uncertain. The aim of the presented study is to assess the role of postoperative cTnI in predicting in-hospital and mid-term outcome in non-selected patients undergoing CABG and to suggest a critical use of cTnI to improve post-operative care of patients with elevated troponin release. Methods: Between May 2000 and February 2003, 230 unselected patients undergoing surgical revascularization had cTnI measured preoperatively and 11 times postoperatively. Patients with unstable angina and recent MI (<7 days) were included in the study. Patients undergoing aortic dissection surgery and those undergoing heart valve procedures with associated CABG as well as patients transferred on emergency in the operative room following complicated percutaneous coronary intervention were excluded. A receiver operating characteristics (ROC) curve was constructed using cTnI postoperative peak values to assess prognostic specificity and sensitivity of the test. 13 ng/ml is the cut-off value used to assess the prognostic significance of peak cTnI postoperative release for short and mid-term outcome for mortality and hospitalization for cardiac causes. Mean and maximal follow-up were 22.6±10.7 and 48.3 months, completeness 90%. Results: 146 patients (63.5%) had postoperative cTnI peak values <13 ng/ml (mean peak value 6.6±3.1 ng/ml), 84 patients (36.5%) had postoperative cTnI peak values >13 ng/ml (mean peak value 45.5±59.9 ng/ml). Patients with peak cTnI >13 ng/ml were older, had lower body mass index and had higher preoperative cTnI values. They required longer cross-clamp time and CPB time. Post-operative results are shown. Hospital death was significantly higher in cTnI >13 ng/ml group (9.5% vs. 0.7%, P = 0.0009). = 0.0009). Multivariate analysis showed that cTnI >13 ng/ml was the only independent predictor of hospital death (OR 10.33, P = 0.04) and hospital death for = 0.04) and hospital death for cardiac causes. Two years follow-up demonstrate that cTnI postoperative release had no influence on mid-term mortality and hospitalization for cardiac causes.Conclusions: The presented is the largest study reporting mid-term survival for CABG patients based on postoperative cTnI release. CTnI is a valuable marker for immediate myocardial damage following coronary bypass operations. CTnI postoperative release does not predict mid-term outcome.
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