Journal article
Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T
Journal of clinical medicine, Vol.12(13), p.4291
06/26/2023
DOI: 10.3390/jcm12134291
PMCID: PMC10342425
PMID: 37445326
Abstract
Objective: Cut-offs for high-sensitivity troponin (hs-Tn) elevations to define prognostically significant peri-operative myocardial injury (PMI) in cardiac surgery is not well-established. We evaluated the associations between peri-operative high-sensitivity troponin T (hs-TnT) elevations and 1-year all-cause mortality in patients undergoing cardiac surgery. Methods: The prognostic significance of baseline hs-TnT and various thresholds for post-operative hs-TnT elevation at different time-points on 1-year all-cause mortality following cardiac surgery were assessed after adjusting for baseline hs-TnT and EuroSCORE in a post-hoc analysis of the ERICCA trial. Results: 1206 patients met the inclusion criteria. Baseline elevation in hs-TnT >x1 99th percentile upper reference limit (URL) was significantly associated with 1-year all-cause mortality (adjusted hazard ratio 1.90, 95% confidence interval 1.15-3.13). In the subgroup with normal baseline hs-TnT (n = 517), elevation in hs-TnT at all post-operative time points was associated with higher 1-year mortality, reaching statistical significance for elevations above: & GE;100 x URL at 6 h; & GE;50 x URL at 12 and 24 h; & GE;35 x URL at 48 h; and & GE;30 x URL at 72 h post-surgery. Elevation in hs-TnT at 24 h & GE; 50 x URL had the optimal sensitivity and specificity (73% and 75% respectively). When the whole cohort of patients was analysed, including those with abnormal baseline hs-TnT (up to 10 x URL), the same threshold had optimal sensitivity and specificity (66% and 70%). Conclusions: Both baseline and post-operative hs-TnT elevations are independently associated with 1-year all-cause mortality in patients undergoing cardiac surgery. The optimal threshold to define a prognostically significant PMI in our study was & GE;50 x URL elevation in hs-TnT at 24 h.
Details
- Title: Subtitle
- Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T
- Creators
- Vikram Sharma - University of IowaHuili Zheng - Hlth Promot Board, Natl Registry Dis, Singapore 168937, SingaporeLuciano Candilio - The Royal Free HospitalJennifer M. Nicholas - London Sch Hyg & Trop Med, Dept Med Stat, Clin Trials Unit, London WC1E 7HT, EnglandTim Clayton - London Sch Hyg & Trop Med, Dept Med Stat, Clin Trials Unit, London WC1E 7HT, EnglandDerek M. Yellon - UCL, Hatter Cardiovasc Inst, London WC1E 6HX, EnglandHeerajnarain Bulluck - University of LeedsDerek J. Hausenloy - UCL, Hatter Cardiovasc Inst, London WC1E 6HX, England
- Resource Type
- Journal article
- Publication Details
- Journal of clinical medicine, Vol.12(13), p.4291
- DOI
- 10.3390/jcm12134291
- PMID
- 37445326
- PMCID
- PMC10342425
- NLM abbreviation
- J Clin Med
- ISSN
- 2077-0383
- eISSN
- 2077-0383
- Publisher
- Mdpi
- Number of pages
- 12
- Grant note
- MOH-STaR21jun-0003; NMRC CG21APR1006; NMRC/CG21APRC006 / Duke-NUS Signature Research Programme - Ministry of Health, Singapore Ministry of Health's National Medical Research Council under its Singapore Translational Research Investigator Award 09/100/05 / Efficacy and Mechanism Evaluation Program (a Medical Research Council) 09/100/05 / Efficacy and Mechanism Evaluation Program (National Institute of Health Research partnership) British Heart Foundation
- Language
- English
- Date published
- 06/26/2023
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984806601402771
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