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Risk stratification with cardiac troponin I in patients undergoing elective coronary artery bypass surgery.
Eur J Cardiothorac Surg. 2005 May; 27(5):861-9.EJ

Abstract

OBJECTIVE

Cardiac troponin I (cTnI) is a highly sensitive and specific marker for postoperative prediction of patients outcome after coronary artery bypass surgery (CABG). Whether preoperatively elevated cTnI levels similarly predict the outcome in patients scheduled for elective CABG is currently unknown.

METHODS

Therefore, a possible correlation between preoperative cTnI levels and perioperative major adverse events and in-hospital mortality after CABG was investigated. CTnI was measured within 24h before surgery in 1405 out of 3124 consecutive elective CABG patients. Out of these patients, 1178 had a preoperative cTnI level below 0.1ng/ml (group 1), 163 patients had a cTnI level between 0.11 and 1.5ng/ml (group 2), and 64 patients had a cTnI level above 1.5ng/ml (group 3). CTnI levels, electrocardiograms, clinical data, adverse events and in-hospital mortality were recorded prospectively. Patients with ST-elevation myocardial infarction less than 7 days before surgery were excluded from the study.

RESULTS

Perioperative myocardial infarction (PMI) occurred in 69/1178 patients (5.9%) in group 1, 14/163 patients (8.6%; odds ratio (OR) 1.5, 95% confidence interval (CI): 0.8-2.8) in group 2, and 11/64 patients (17.2%; OR 3.3, CI: 1.6-7.0) in group 3 (overall: P<0.001, Cochran-Armitage trend test). Low cardiac output syndrome (LCOS) occurred in 19/1178 patients (1.6%), 9/163 (5.5%; OR 3.6, CI: 1.5-8.5), and 7/64 patients (10.9%; OR 7.5, CI: 2.7-19.8) (overall: P<0.001, group 1 vs. group 2: P<0.002), respectively. In-hospital mortality was 1.7% in group 1 and 3.1% in group 2, but 6.3% (OR 3.9, CI: 1.1-12.5) in group 3 (overall: P<0.01, group 1 vs. group 2: P=NS). Intensive care and hospital stay were significantly longer in group 3 compared to groups 1 and 2. Univariate and multivariate logistic regression analysis confirmed the statistically significant relationship between cTnI and PMI, LCOS and in-hospital mortality, respectively (P<0.001).

CONCLUSIONS

Risk stratification by measurement of cTnI levels within 24h before elective CABG clearly identifies a subgroup of patients with increased risk for postoperative adverse outcome and in-hospital mortality.

Authors+Show Affiliations

Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Clinic of Essen, Germany. matthias.thielmann@uni-essen.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15848327

Citation

Thielmann, Matthias, et al. "Risk Stratification With Cardiac Troponin I in Patients Undergoing Elective Coronary Artery Bypass Surgery." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 27, no. 5, 2005, pp. 861-9.
Thielmann M, Massoudy P, Neuhäuser M, et al. Risk stratification with cardiac troponin I in patients undergoing elective coronary artery bypass surgery. Eur J Cardiothorac Surg. 2005;27(5):861-9.
Thielmann, M., Massoudy, P., Neuhäuser, M., Knipp, S., Kamler, M., Marggraf, G., Piotrowski, J., & Jakob, H. (2005). Risk stratification with cardiac troponin I in patients undergoing elective coronary artery bypass surgery. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 27(5), 861-9.
Thielmann M, et al. Risk Stratification With Cardiac Troponin I in Patients Undergoing Elective Coronary Artery Bypass Surgery. Eur J Cardiothorac Surg. 2005;27(5):861-9. PubMed PMID: 15848327.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk stratification with cardiac troponin I in patients undergoing elective coronary artery bypass surgery. AU - Thielmann,Matthias, AU - Massoudy,Parwis, AU - Neuhäuser,Markus, AU - Knipp,Stephan, AU - Kamler,Markus, AU - Marggraf,Günter, AU - Piotrowski,Jarowit, AU - Jakob,Heinz, PY - 2004/10/14/received PY - 2005/01/19/revised PY - 2005/01/21/accepted PY - 2005/4/26/pubmed PY - 2005/9/24/medline PY - 2005/4/26/entrez SP - 861 EP - 9 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 27 IS - 5 N2 - OBJECTIVE: Cardiac troponin I (cTnI) is a highly sensitive and specific marker for postoperative prediction of patients outcome after coronary artery bypass surgery (CABG). Whether preoperatively elevated cTnI levels similarly predict the outcome in patients scheduled for elective CABG is currently unknown. METHODS: Therefore, a possible correlation between preoperative cTnI levels and perioperative major adverse events and in-hospital mortality after CABG was investigated. CTnI was measured within 24h before surgery in 1405 out of 3124 consecutive elective CABG patients. Out of these patients, 1178 had a preoperative cTnI level below 0.1ng/ml (group 1), 163 patients had a cTnI level between 0.11 and 1.5ng/ml (group 2), and 64 patients had a cTnI level above 1.5ng/ml (group 3). CTnI levels, electrocardiograms, clinical data, adverse events and in-hospital mortality were recorded prospectively. Patients with ST-elevation myocardial infarction less than 7 days before surgery were excluded from the study. RESULTS: Perioperative myocardial infarction (PMI) occurred in 69/1178 patients (5.9%) in group 1, 14/163 patients (8.6%; odds ratio (OR) 1.5, 95% confidence interval (CI): 0.8-2.8) in group 2, and 11/64 patients (17.2%; OR 3.3, CI: 1.6-7.0) in group 3 (overall: P<0.001, Cochran-Armitage trend test). Low cardiac output syndrome (LCOS) occurred in 19/1178 patients (1.6%), 9/163 (5.5%; OR 3.6, CI: 1.5-8.5), and 7/64 patients (10.9%; OR 7.5, CI: 2.7-19.8) (overall: P<0.001, group 1 vs. group 2: P<0.002), respectively. In-hospital mortality was 1.7% in group 1 and 3.1% in group 2, but 6.3% (OR 3.9, CI: 1.1-12.5) in group 3 (overall: P<0.01, group 1 vs. group 2: P=NS). Intensive care and hospital stay were significantly longer in group 3 compared to groups 1 and 2. Univariate and multivariate logistic regression analysis confirmed the statistically significant relationship between cTnI and PMI, LCOS and in-hospital mortality, respectively (P<0.001). CONCLUSIONS: Risk stratification by measurement of cTnI levels within 24h before elective CABG clearly identifies a subgroup of patients with increased risk for postoperative adverse outcome and in-hospital mortality. SN - 1010-7940 UR - https://www.unboundmedicine.com/medline/citation/15848327/Risk_stratification_with_cardiac_troponin_I_in_patients_undergoing_elective_coronary_artery_bypass_surgery_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1016/j.ejcts.2005.01.043 DB - PRIME DP - Unbound Medicine ER -