Original Research ARTICLE
CLINICAL RELEVANCE OF TROPONIN T PROFILE FOLLOWING CARDIAC SURGERY
- 1Cardiovascular Surgery, Universitätsspital Bern, Switzerland
- 2Queen Mary University of London, United Kingdom
- 3Clinic for Cardiovascular Surgery, Inselspital, Switzerland
Background: Peak postoperative cardiac troponin T (cTnT) independently predicts mid- and long-term outcome of cardiac surgery patients. A few studies however reported 2 peaks of cTnT over the first 48-72 hours following myocardial reperfusion. The aim of the current study was to better understand underlying reasons of this cTnT profile and possible consequences on clinical outcome.
Methods: All consecutive adult cardiac surgical procedures performed with an extra-corporeal circulation during a >6 years period were retrospectively evaluated. Patients with a myocardial infarction (MI) <8 days were excluded. cTnT profile of patients with at least one value ≥1ng/mL value were categorized according to the time occurrence of the peak value. Univariable and multivariable analysis were performed to identify factors influencing early versus late increase of cTnT values, and to verify the correlation of early versus late increase with clinical outcome.
Results: Data of 5146 patients were retrieved from our prospectively managed registry. From 953 with at least one cTnT value ≥ 1ng/mL, peak occurred ≤6 hours (n=22), >6 to ≤12 hours (n=366), >12 to ≤18 hours (n=176), >18 to ≤24 hours (171), >24 hours (218). Age (OR: 1.023; CI:1.016-1.030) and isolated CABG (OR: 1.779; CI: 1.114-2.839) were independent predictors of a late increase of cTnT over a limit of 1 ng/ml (p<0.05), whereas isolated valve procedures (OR:0.685; CI: 0.471-0.998) and cross-clamp duration (OR: 0.993; CI: 0.990-0.997) independently predicted an early elevation (p<0.05). Delayed elevation over 1 ng/ml correlated with a higher rate of post-operative complications including MI (19.8% vs. 7.2%), new renal insufficiency (16.3% vs. 6.7%), MACCE (32.0% vs. 15.5%) or death (7.4% vs. 4.4%).
Conclusion: Profile of cTnT elevation following cardiac surgery depends on patients’ intrinsic factors, type of surgery and duration of cross-clamp time. Delayed increase is of higher clinically relevance than prompt post-operative elevation.
Keywords: cardiac surgery, CABG – coronary artery bypass graft, Troponin, Cardiac Biomarkers, complications
Received: 20 Aug 2018;
Accepted: 03 Dec 2018.
Edited by:Massimo Caputo, University of Bristol, United Kingdom
Reviewed by:Antonio Miceli, Istituto Clinico Sant'Ambrogio, Italy
Pradeep Narayan, Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), India
Copyright: © 2018 Tevaearai Stahel, Do, Klaus, Gahl, Locca, Göber and Carrel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Prof. Hendrik T. Tevaearai Stahel, Universitätsspital Bern, Cardiovascular Surgery, Bern, 3010, Switzerland, email@example.com