Usefulness of cardiac troponin I in patients undergoing open heart surgery (original) (raw)
Related papers
Prognostic Significance of Elevated Cardiac Troponin I After Heart Surgery
The Annals of Thoracic Surgery, 2007
Background. Cardiac troponin I (cTnI) measured after heart surgery has been associated with operative mortality. We sought to determine whether measuring cTnI after heart surgery provides additional prognostic information beyond that provided by validated preoperative risk scores, the Veterans Affairs (VA) risk score and the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Methods. We retrospectively collected cTnI levels measured 24 hours after surgery in 1,186 patients who underwent coronary artery bypass graft surgery (n ؍ 696) or valve surgery (n ؍ 490). The outcomes were operative death and perioperative myocardial infarction. The ability of the cTnI and the risk scores to discriminate patients who did or did not have the study outcomes was assessed by the area under the receiver operating curve (c-index). Results. Mean age was 66 ؎ 10 years. Median cTnI was 38 ng/mL after valve surgery versus 18 ng/mL after coronary artery bypass graft surgery (p < 0.0001). There were 51 operative deaths (4.3%) and 142 perioperative myocardial infarctions (12%). For every 50 ng/mL increase in cTnI, the odds of operative death increased by 40% (odds ratio, 1.4; 95% confidence interval: 1.2 to 1.6) after coronary artery bypass graft surgery and by 30% (odds ratio, 1.3; 95% confidence interval: 1.1 to 1.5) after valve surgery. Cardiac troponin I was a significant independent correlate of perioperative myocardial infarction and death (p < 0.0001) with a c-index of 0.70 for death. Addition of cTnI improved the c-indexes of the risk scores for predicting death (from 0.75 to 0.79 for the VA risk score; p ؍ 0.1; and from 0.69 to 0.77 for the Euro-SCORE; p ؍ 0.005). Conclusions. Postoperative cTnI measured 24 hours after heart surgery is independently associated with operative death and perioperative myocardial infarction and improves the ability to predict operative mortality in comparison with preoperative risk scores alone.
Disease Markers, 2013
Background. Cardiac troponin levels have been reported to add value in the detection of cardiovascular complications in noncardiac surgery. A sensitive cardiac troponin I (cTnI) assay could provide more accurate prognostic information. Methods. This study prospectively enrolled 142 patients with at least one Revised Cardiac Risk Index risk factor who underwent noncardiac surgery. cTnI levels were measured postoperatively. Short-term cardiac outcome predictors were evaluated. Results. cTnI elevation was observed in 47 patients, among whom 14 were diagnosed as having myocardial infarction (MI). After 30 days, 16 patients had major adverse cardiac events (MACE). Excluding patients with a final diagnosis of MI, predictors of cTnI elevation included dialysis, history of heart failure, transoperative major bleeding, and elevated levels of pre-and postoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP). Maximal cTnI values showed the highest sensitivity (94%), specificity (75%), and overall accuracy (AUC 0.89; 95% CI 0.80-0.98) for postoperative MACE. Postoperative cTnI peak level (OR 9.4; 95% CI 2.3-39.2) and a preoperative NT-proBNP level ≥917 pg/mL (OR 3.47; 95% CI 1.05-11.6) were independent risk factors for MACE. Conclusions. cTnI was shown to be an independent prognostic factor for cardiac outcomes and should be considered as a component of perioperative risk assessment.
Cardiac Troponin: a New Biochemical Marker for Peri-operative Myocardial Injury
European Journal of Vascular and Endovascular Surgery, 2001
who have objective evidence of MI. 6 The ECG is difficult to interpret in the post-operative setting and often Peri-operative myocardial infarction (MI) occurs in does not display the classical ST segment elevation of acute myocardial infarction. 7 Lastly, even if there is a 5-10% of patients undergoing major vascular surgery, is fatal in 50% of these cases and in total will account significant rise in creatine kinase leaked from dying myocardial cells (CK-MB) this may be masked by for more than 50% of all post-operative deaths. 1 An even larger proportion of operated patients will suffer large quantities of creatine kinase (CK) released from skeletal muscle as the result of direct surgical trauma cardiac complications, which may be fatal or non-fatal, that are not demonstrably related to peri-operative or ischaemia/reperfusion injury. 8 This makes the CK/ CK-MB ratio difficult to interpret. MI. 2 These complications may have metabolic causes, but are perhaps more likely to be due to myocardial infarction that cannot be detected by the standard diagnostic tests for peri-operative MI. 3,4 This injury Micro-infarction and the acute coronary may be referred to as minor myocardial injury or syndromes micro-infarction.
Journal of Clinical Trials, 2017
Although Acute Myocardial Infarct (AMI) from its classic symptomatology added or not to electrocardiographic changes is a significant cause of perioperative associated mortality, when it is only plotted from the enzymatic curve, recent data points towards the existence of similar mortality. Considered as a biological marker of a more recent generation, the high sensitivity cardiac troponin (hs-cTnT) analysis may give clues on whether a rupture of the oxygen (O 2) is occurring or not offer and demand balance, without any association with other manifestations, which opens a gap to be investigated, when the diagnostic search after myocardial ischemia (MI), something that is not done unless the patient is under high risk or has a confirmed history of Coronary Artery Disease (CAD). This review explores the possible associated factors when analyzing the risks of AMI and MI in the perioperative period.
JAMA, 2017
Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS). To determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality). Prospective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement. Starting in October 2008, participants were recruited at 23 centers in 13 countries; follow-up finished in December 2013. Patients had hsTnT measurements 6 to 12 hours after surgery and daily for 3 days; 40.4% had a preoperative hsTnT measurement. A modified Mazumdar approach (an iterative process) was used to determine if there were hsTnT thresholds associated with risk of death and had an adjusted hazard ratio (HR) of 3.0 or higher and a risk of 30-da...
Cardiac troponin I as an early marker of myocardial damage after coronary bypass surgery
European journal of …, 1998
Study objective: To evaluate the performance of cardiac specific markers, cardiac troponin I (cTnI) and CK-MB by mass assay (CK-MB mass), for the early diagnosis of myocardial ischemia and/or infarction after coronary bypass surgery. Methods: Prospective clinical, electrocardiograpic and biologic follow-up of 117 patients undergoing isolated coronary surgery with the use of intermittent anterograde normothermic blood cardioplegia. Blood samples for biochemical analysis were drawn before surgery (T 0) and at 2 (T 1), 6 (T 2), 10 (T 3) and 20 h (T 4) after aortic cross-clamp release. Without knowledge of the biochemical data, patients were classified according to the electrocardiographic evolution into two groups: group 1, uneventful recovery and group 2, evidence of ischemia/infarction based on continuous ST-T segment monitoring and 12-lead ECG. Results: No patients had abnormal markers at T 0. At T 1 , although both markers were elevated, no difference was noted between the two groups. At T 2, 6 h after surgery, cTnI and CK-MB mass levels were significantly higher in group 2 than in group 1 (median = 17 vg/l,
Clinical Research in Cardiology, 2021
Perioperative myocardial infarction/injury (PMI) diagnosed by high-sensitivity troponin (hs-cTn) T is frequent and a prognostically important complication of non-cardiac surgery. We aimed to evaluate the incidence and outcome of PMI diagnosed using hs-cTnI, and compare it to PMI diagnosed using hs-cTnT. We prospectively included 2455 patients at high cardiovascular risk undergoing 3111 non-cardiac surgeries, for whom hs-cTnI and hs-cTnT concentrations were measured before surgery and on postoperative days 1 and 2. PMI was defined as a composite of perioperative myocardial infarction (PMIInfarct) and perioperative myocardial injury (PMIInjury), according to the Fourth Universal Definition of Myocardial Infarction. All-cause mortality was the primary endpoint. Using hs-cTnI, the incidence of overall PMI was 9% (95% confidence interval [CI] 8–10%), including PMIInfarct 2.6% (95% CI 2.0–3.2) and PMIInjury 6.1% (95% CI 5.3–6.9%), which was lower versus using hs-cTnT: overall PMI 15% (95%...