Prognostic value of high-sensitivity cardiac troponin I early after coronary artery bypass graft surgery

Abstract

Background: The diagnosis of periprocedural myocardial infarction (PMI) after coronary artery bypass graft (CABG) is based on biochemical markers along with clinical and instrumental findings. However, there is not a clear cutoff value of high-sensitivity cardiac troponin (hs-cTn) to identify PMI. We hypothesized that isolated hs-cTn concentrations in the first 24 h following CABG could predict cardiac adverse events (in-hospital death and PMI) and/or left ventricular ejection fraction (LVEF) decrease.

Methods: We retrospectively enrolled all consecutive adult patients undergoing CABG, alone or in association with other cardiac surgery procedures, over 1 year. Hs-cTn I concentrations (Access, Beckman Coulter) were serially measured in the post-operative period and analyzed according to post-operative outcomes.

Results: 300 patients were enrolled; 71.3% underwent CABG alone, 33.7% for acute coronary syndrome. Most patients showed hs-cTn I values superior to the limit required by the latest guidelines for the diagnosis of PMI. Five patients (1.7%) died, 8% developed a PMI, 10.6% showed a LVEF decrease ≥ 10%. Hs-cTn I concentrations did not significantly differ with respect to death and/or PMI whereas they were associated with LVEF decrease ≥ 10% (p value < 0.005 at any time interval), in particular hs-cTn I values at 9-12 h post-operatively. A hs-cTn I cutoff of 5556 ng/L, a value 281 (for males) and 479 (for females) times higher than the URL, at 9-12 h post-operatively was identified, representing the best balance between sensitivity (55%) and specificity (79%) in predicting LVEF decrease ≥ 10%.

Conclusions: Hs-cTn I at 9-12 h post-CABG may be useful to early identify patients at risk for LVEF decrease and to guide early investigation and management of possible post-operative complications.

Keywords: Coronary artery bypass graft; High-sensitivity cardiac troponin I; Left ventricular ejection fraction; Periprocedural myocardial infarction.

Fig. 1

Relationship between post-operative hs-cTn I serial values and clinical outcomes. A: In-hospital death / PMI. B: In-hospital death. C: PMI. D: LVEF decrease ≥ 10%. hs-cTn I: high-sensitivity cardiac troponin I; LVEF: left ventricular ejection fraction; PMI: peri-operative myocardial infarction

Fig. 1

Relationship between post-operative hs-cTn I serial values and clinical outcomes. A: In-hospital death / PMI. B: In-hospital death. C: PMI. D: LVEF decrease ≥ 10%. hs-cTn I: high-sensitivity cardiac troponin I; LVEF: left ventricular ejection fraction; PMI: peri-operative myocardial infarction