Abstract
Abstract 14636: Defining Prognostically Significant Perioperative Myocardial Injury During CABG Surgery Using hs-Troponin T - Insights From the ERICCA Trial
Circulation (New York, N.Y.), Vol.140(Suppl_1), A14636
11/19/2019
Abstract
Introduction: Current definitions of perioperative myocardial injury (PMI) during coronary artery bypass graft surgery are based on arbitrarily selected cut-offs of isolated elevations in serum cardiac troponin.
Hypothesis: We investigated the association between perioperative elevations in serum high-sensitive Troponin-T (hs-TnT) with one-year all-cause mortality in order to better define the optimal cut-off level for prognostically significant PMI.
Methods: This study was a retrospective analysis of the ERICCA trial, a 1621 patient study which had failed to show benefits of remote ischemic conditioning on clinical outcomes following CABG surgery. Hs-TnT was measured at baseline, 6, 12, 24, 48 and 72 hours post-surgery. We investigated the associations between peak hs-TnT values in the first 48 hours (pk-HsTnT-48) and area-under-the-curve (AUC) for hs-TNT over 72 hours (AUC-hs-TnT-72) with one-year all-cause mortality.
Results: 1261 patients were included in the final analysis. Hs-TnT elevation at 48 hours post-surgery had the strongest association with one-year all-cause mortality, with adjusted HR 1.83 (95% CI 1.40-2.39, p<0.001) and adjusted AUC 0.71 (0.65-0.77), when compared with hs-TnT elevations at 6, 12, 24 and 72 hours, as well as AUC-hs-TnT-72. We next compared the association of different elevations of hs-TnT (25x, 35x, 50x, 75x and 100x URL) at 48 hours with mortality post-surgery and found that hs-TnT >35xURL at 48 hours provided the best balance between sensitivity (60%) and specificity (68%), with adjusted HR 1.95 (1.20-3.14) and adjusted AUC 0.71 (0.65-0.77), regardless of the presence/absence of EKG changes suggestive of myocardial injury/infarction.
Conclusions: Perioperative elevation of serum hs-TnT >35xURL at 48 hours post-surgery was most strongly associated with one-year all-cause mortality after CABG surgery, suggesting that this threshold of hs-TnT elevation can be used to define prognostically significant PMI.
Details
- Title: Subtitle
- Abstract 14636: Defining Prognostically Significant Perioperative Myocardial Injury During CABG Surgery Using hs-Troponin T - Insights From the ERICCA Trial
- Creators
- Vikram Sharma - Cleveland ClinicHuili Zheng - Health Promotion BoardHeerajnarain Bulluck - Cardiology, Golden Jubilee National Hosp, Clydebank, United KingdomJennifer Nicholas - Dept of Med Statistics,, London Sch of Hygiene & Tropical Medicine, London, United KingdomTim Clayton - Dept of Med Statistics, London Sch of Hygiene & Tropical Medicine, London, United KingdomDerek Yellon - Molecular & Cellular Cardiology, The Hatter Cardiovascular Institute, London, United KingdomDerek Hausenloy - Cardiovascular Medicine, The Hatter Cardiovascular Institute, London, United Kingdom
- Resource Type
- Abstract
- Publication Details
- Circulation (New York, N.Y.), Vol.140(Suppl_1), A14636
- Publisher
- American Heart Association, Inc.
- ISSN
- 0009-7322
- Language
- English
- Date published
- 11/19/2019
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984808213702771
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