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* From the Department of Thoracic and Cardiovascular Surgery (Drs. Thielmann, Massoudy, Knipp, Kamler, Piotrowski, and Jakob), Institute for Medical Informatics, Biometry, and Epidemiology (Dr. Neuhäuser), and Department of Clinical Chemistry (Dr. Mann), West-German Heart Center Essen, University Clinic of Essen, Essen, Germany.
Correspondence to: Matthias Thielmann, MD, Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Clinic of Essen, Hufelandstraße 55, 45122 Essen, Germany; e-mail: matthias.thielmann{at}uni-essen.de
Study objectives: Elevated levels of cardiac troponin I (cTnI) have been associated with adverse short-term and long-term outcomes in acute coronary syndrome (ACS) patients and in patients who underwent coronary artery bypass grafting (CABG); however, the prognostic implications of preoperative cTnI determination have not been investigated so far.
Design and setting: Retrospective study in a department of cardiothoracic surgery of a university hospital.
Patients and methods: A possible correlation between preoperative cTnI levels and major adverse cardiac events (MACE) and in-hospital mortality in CABG patients with non–ST-segment elevation ACS (NSTE-ACS) was investigated. cTnI was determined in 1,978 of 3,124 consecutive CABG patients. Among these, 1,592 patients had preoperative cTnI levels < 0.1 ng/mL and therefore served as control subjects (group 1), 265 patients had NSTE-ACS with cTnI levels from 0.11 to 1.5 ng/mL (group 2), and 121 patients had NSTE-ACS with cTnI levels > 1.5 ng/mL (group 3). cTnI levels, clinical data, MACE, and in-hospital mortality were recorded prospectively. Logistic regression and receiver operating characteristic analyses were applied to determine prognostic cutoff values of cTnI.
Results: Perioperative myocardial infarction was found in 5.8% of the patients in group 1, 8.3% of the patients in group 2 (odds ratio [OR], 1.5; 95% confidence interval [CI], 0.9 to 2.5), and 18.2% patients in group 3 (OR, 3.6; 95% CI, 2.1 to 6.2; p < 0.0001, Cochran-Armitage trend test). Low cardiac output syndrome occurred in 1.5% of patients in group 1, 4.2% of patients in group 2 (OR, 2.8; 95% CI, 1.3 to 6.1), and 10.9% patients in group 3 (OR, 6.5; 95% CI, 2.9 to 14.4; p < 0.0001). In-hospital mortality was 1.5% in group 1, 3.0% in group 2 (OR, 2.0; 95% CI, 0.8 to 4.8), but 6.6% in group 3 (OR, 4.6; 95% CI, 1.9 to 11.1; p < 0.0001). Univariate and multivariate logistic regression analyses identified cTnI as the strongest preoperative predictor for MACE and in-hospital mortality, respectively.
Conclusions: Preoperative cTnI measurement before CABG appears as a powerful and independent determinant of short-term surgical risk in patients with NSTE-ACS.
Key Words: cardiac troponin I • coronary artery bypass grafting • non–ST-segment elevation acute coronary syndrome • risk stratification
This article has been cited by other articles:
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  M. Thielmann, P. Massoudy, M. Neuhauser, K. Tsagakis, G. Marggraf, M. Kamler, K. Mann, R. Erbel, and H. Jakob Prognostic Value of Preoperative Cardiac Troponin I in Patients Undergoing Emergency Coronary Artery Bypass Surgery With Non-ST-Elevation or ST-Elevation Acute Coronary Syndromes Circulation, July 4, 2006; 114(1_suppl): I-448 - I-453. [Abstract] [Full Text] [PDF]
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P. Monteiro and on behalf of the Portuguese Registry on Acute Coro Impact of Early Coronary Artery Bypass Graft in an Unselected Acute Coronary Syndrome Patient Population Circulation, July 4, 2006; 114(1_suppl): I-467 - I-472. [Abstract] [Full Text] [PDF]
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