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High-Sensitivity Troponin and Mortality After Cardiac Surgery
Quick Takes
- This single-center study including 8,292 patients showed that elevated high-sensitivity troponin values following cardiac surgery are associated with 30-day mortality.
- Greater increases in high-sensitivity troponin are seen following CABG than aortic valve replacement (AVR).
- High-sensitivity troponin elevations above procedure-specific thresholds have greater prognostic significance following CABG than AVR (hazard ratios for 30-day mortality: 12.56 following CABG, 4.44 following AVR).
Study Questions:
What is the association between perioperative myocardial injury, as evidenced by postoperative troponin release, and mortality following cardiac surgery?
Methods:
This retrospective study included consecutive patients undergoing cardiac surgery from 2010–2020 at a single center in Austria. Patients who underwent cardiac surgery without cardiopulmonary bypass and those without pre- and postoperative high-sensitivity cardiac troponin T (hs-cTnT) values were excluded. Operative risk was assessed with the current European System for Cardiac Operative Risk Evaluation score (EuroSCORE II). The primary outcome was 30-day mortality, and the secondary outcome 5-year mortality.
Results:
The study included 8,292 patients (median age 68 years, 31.1% female, median body mass index 26.0 kg/m2, mean EuroSCORE II 4.2%). The median preoperative hs-cTnT value was 13.8 ng/L. Isolated coronary artery bypass grafting (CABG) was performed in 2,676 patients (32.3%), isolated aortic valve replacement (AVR) in 1,159 patients (14.0%), and other cardiac surgery in 4,457 patients (53.8%). Median follow-up time was 4.5 years.
Overall 30-day mortality was 2.5%. The median peak concentration of postoperative hs-cTnT was higher in the CABG group than in the AVR group (1044 vs. 502 ng/L). Risk of 30-day mortality increased with every unit of log peak hs-cTnT after all types of surgery. In receiver operating characteristic analyses, the highest predictive value of hs-cTnT was for CABG patients (area under the curve [AUC] 0.796) and lower in AVR patients (AUC 0.694). The threshold hs-cTnT levels for predicting 30-day mortality were 2385 ng/L (170 x upper limit of normal) for CABG (hazard ratio, 12.56; p < 0.001) and 568 ng/L (41 x upper limit of normal) for AVR (hazard ratio, 4.44; p = 0.004). In Kaplan-Meier analyses, patients with above-threshold postoperative hs-cTnT had significantly increased 5-year mortality following CABG but not AVR.
Conclusions:
Following cardiac surgery, high hs-cTnT levels are associated with increased 30-day mortality. Greater increases in hs-cTnT are seen following CABG than AVR, and hs-cTnT elevations have greater prognostic significance following CABG than AVR. Five-year mortality is increased in patients with high hs-cTnT following CABG but not AVR.
Perspective:
These findings would need to be validated in multicenter studies before routine pre- and postoperative troponin assessments could be justified in routine clinical practice. Thresholds for hs-cTnT would likely vary in obese and nonobese populations.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention
Keywords: Biomarkers, Cardiac Surgical Procedures, Coronary Artery Bypass, Transcatheter Aortic Valve Replacement, Troponin T
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