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Review
. 2023 Jan 7;44(2):100-112.
doi: 10.1093/eurheartj/ehac604.

Cardiac troponin release following coronary artery bypass grafting: mechanisms and clinical implications

Samuel Heuts  1   2 , Can Gollmann-Tepeköylü  3 , Ellen J S Denessen  2   4 , Jules R Olsthoorn  1   5 , Jamie L R Romeo  1 , Jos G Maessen  1   2 , Arnoud W J van 't Hof  2   6   7 , Otto Bekers  2   4 , Ola Hammarsten  8 , Leo Pölzl  3   9 , Johannes Holfeld  3 , Nikolaos Bonaros  3 , Iwan C C van der Horst  2   10 , Sean M Davidson  11 , Matthias Thielmann  12 , Alma M A Mingels  2   4
Affiliations
Review

Cardiac troponin release following coronary artery bypass grafting: mechanisms and clinical implications

Samuel Heuts et al. Eur Heart J. .

Abstract

The use of biomarkers is undisputed in the diagnosis of primary myocardial infarction (MI), but their value for identifying MI is less well studied in the postoperative phase following coronary artery bypass grafting (CABG). To identify patients with periprocedural MI (PMI), several conflicting definitions of PMI have been proposed, relying either on cardiac troponin (cTn) or the MB isoenzyme of creatine kinase, with or without supporting evidence of ischaemia. However, CABG inherently induces the release of cardiac biomarkers, as reflected by significant cTn concentrations in patients with uncomplicated postoperative courses. Still, the underlying (patho)physiological release mechanisms of cTn are incompletely understood, complicating adequate interpretation of postoperative increases in cTn concentrations. Therefore, the aim of the current review is to present these potential underlying mechanisms of cTn release in general, and following CABG in particular (Graphical Abstract). Based on these mechanisms, dissimilarities in the release of cTnI and cTnT are discussed, with potentially important implications for clinical practice. Consequently, currently proposed cTn biomarker cut-offs by the prevailing definitions of PMI might warrant re-assessment, with differentiation in cut-offs for the separate available assays and surgical strategies. To resolve these issues, future prospective studies are warranted to determine the prognostic influence of biomarker release in general and PMI in particular.

Keywords: Cardiac surgery; Cardiac troponin; Coronary artery bypass grafting; Myocardial infarction; Periprocedural myocardial infarction.

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Conflict of interest statement

Conflict of interest: A.M.A.M. has received nonfinancial support from Abbott Diagnostics and Roche Diagnostics. These manufacturers had no role in the preparation of this review, or the decision to submit the article for publication. A.W.J.V.H. reports his institution received unrestricted grants from Abbott, Roche Medtronic, Boehringer Ingelheim and Astra Zeneca, unrelated to this work. All other authors have no conflicts of interest to declare.

Figures

Graphical Abstract
Graphical Abstract
Possible mechanisms of cardiac troponin release and their mechanistic causes in patients undergoing CABG (Barry van Varik, Pulse Medical Art). CABG, coronary artery bypass grafting; cTnI, cardiac troponin I; cTnT, cardiac troponin T; LV, left ventricular.
Figure 1
Figure 1
An overview of possible mechanisms of cardiac troponin release (Barry van Varik, Pulse Medical Art).
Figure 2
Figure 2
Cardiac troponin release patterns following on- and off-pump coronary artery bypass grafting (A) and differences in cardiac troponin I and cardiac troponin T release following coronary artery bypass grafting (B). (A) Following coronary artery bypass grafting and off-pump coronary artery bypass grafting (based on data from Heuts et al. and based on cardiac troponin T exclusively for assay comparability). (B) Cardiac troponin I vs. cardiac troponin T following coronary artery bypass grafting (based on Heuts et al. and Denessen et al.). Data in this figure were derived from a systematic review and meta-analysis of all available literature on postoperative high-sensitivity cardiac troponin T and I measurements following isolated coronary artery bypass grafting. Assays used for this analysis were Abbott Architect, Siemens Advia Centaur, Siemens Dimension Vista, Beckman Access2 (high-sensitivity cardiac troponin I), and Roche (high-sensitivity cardiac troponin T). All absolute concentrations of the individual studies per assay were corrected to the assay-specific upper reference limit before incorporating the data into the figure. CABG, coronary artery bypass grafting; cTnI, cardiac troponin I; cTnT, cardiac troponin T; OPCAB, off-pump coronary artery bypass grafting; URL, upper reference limit.
See this image and copyright information in PMC

References

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