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Prognostic significance of elevated cardiac troponin I after heart surgery.
Ann Thorac Surg. 2007 May; 83(5):1744-50.AT

Abstract

BACKGROUND

Cardiac troponin I (cTnI) measured after heart surgery has been associated with operative mortality. We sought to determine whether measuring cTnI after heart surgery provides additional prognostic information beyond that provided by validated preoperative risk scores, the Veterans Affairs (VA) risk score and the European System for Cardiac Operative Risk Evaluation (EuroSCORE).

METHODS

We retrospectively collected cTnI levels measured 24 hours after surgery in 1,186 patients who underwent coronary artery bypass graft surgery (n = 696) or valve surgery (n = 490). The outcomes were operative death and perioperative myocardial infarction. The ability of the cTnI and the risk scores to discriminate patients who did or did not have the study outcomes was assessed by the area under the receiver operating curve (c-index).

RESULTS

Mean age was 66 +/- 10 years. Median cTnI was 38 ng/mL after valve surgery versus 18 ng/mL after coronary artery bypass graft surgery (p < 0.0001). There were 51 operative deaths (4.3%) and 142 perioperative myocardial infarctions (12%). For every 50 ng/mL increase in cTnI, the odds of operative death increased by 40% (odds ratio, 1.4; 95% confidence interval: 1.2 to 1.6) after coronary artery bypass graft surgery and by 30% (odds ratio, 1.3; 95% confidence interval: 1.1 to 1.5) after valve surgery. Cardiac troponin I was a significant independent correlate of perioperative myocardial infarction and death (p < 0.0001) with a c-index of 0.70 for death. Addition of cTnI improved the c-indexes of the risk scores for predicting death (from 0.75 to 0.79 for the VA risk score; p = 0.1; and from 0.69 to 0.77 for the EuroSCORE; p = 0.005).

CONCLUSIONS

Postoperative cTnI measured 24 hours after heart surgery is independently associated with operative death and perioperative myocardial infarction and improves the ability to predict operative mortality in comparison with preoperative risk scores alone.

Authors+Show Affiliations

Division of Cardiology, Veterans Affairs Medical Center and the University of Minnesota, Minneapolis, Minnesota 55417, USA. adaba001@umn.eduNo affiliation info availableNo 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
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

17462392

Citation

Adabag, A Selcuk, et al. "Prognostic Significance of Elevated Cardiac Troponin I After Heart Surgery." The Annals of Thoracic Surgery, vol. 83, no. 5, 2007, pp. 1744-50.
Adabag AS, Rector T, Mithani S, et al. Prognostic significance of elevated cardiac troponin I after heart surgery. Ann Thorac Surg. 2007;83(5):1744-50.
Adabag, A. S., Rector, T., Mithani, S., Harmala, J., Ward, H. B., Kelly, R. F., Nguyen, J. T., McFalls, E. O., & Bloomfield, H. E. (2007). Prognostic significance of elevated cardiac troponin I after heart surgery. The Annals of Thoracic Surgery, 83(5), 1744-50.
Adabag AS, et al. Prognostic Significance of Elevated Cardiac Troponin I After Heart Surgery. Ann Thorac Surg. 2007;83(5):1744-50. PubMed PMID: 17462392.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic significance of elevated cardiac troponin I after heart surgery. AU - Adabag,A Selcuk, AU - Rector,Thomas, AU - Mithani,Salima, AU - Harmala,John, AU - Ward,Herbert B, AU - Kelly,Rosemary F, AU - Nguyen,John T, AU - McFalls,Edward O, AU - Bloomfield,Hanna E, PY - 2006/04/12/received PY - 2006/12/26/revised PY - 2006/12/29/accepted PY - 2007/4/28/pubmed PY - 2007/5/17/medline PY - 2007/4/28/entrez SP - 1744 EP - 50 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 83 IS - 5 N2 - BACKGROUND: Cardiac troponin I (cTnI) measured after heart surgery has been associated with operative mortality. We sought to determine whether measuring cTnI after heart surgery provides additional prognostic information beyond that provided by validated preoperative risk scores, the Veterans Affairs (VA) risk score and the European System for Cardiac Operative Risk Evaluation (EuroSCORE). METHODS: We retrospectively collected cTnI levels measured 24 hours after surgery in 1,186 patients who underwent coronary artery bypass graft surgery (n = 696) or valve surgery (n = 490). The outcomes were operative death and perioperative myocardial infarction. The ability of the cTnI and the risk scores to discriminate patients who did or did not have the study outcomes was assessed by the area under the receiver operating curve (c-index). RESULTS: Mean age was 66 +/- 10 years. Median cTnI was 38 ng/mL after valve surgery versus 18 ng/mL after coronary artery bypass graft surgery (p < 0.0001). There were 51 operative deaths (4.3%) and 142 perioperative myocardial infarctions (12%). For every 50 ng/mL increase in cTnI, the odds of operative death increased by 40% (odds ratio, 1.4; 95% confidence interval: 1.2 to 1.6) after coronary artery bypass graft surgery and by 30% (odds ratio, 1.3; 95% confidence interval: 1.1 to 1.5) after valve surgery. Cardiac troponin I was a significant independent correlate of perioperative myocardial infarction and death (p < 0.0001) with a c-index of 0.70 for death. Addition of cTnI improved the c-indexes of the risk scores for predicting death (from 0.75 to 0.79 for the VA risk score; p = 0.1; and from 0.69 to 0.77 for the EuroSCORE; p = 0.005). CONCLUSIONS: Postoperative cTnI measured 24 hours after heart surgery is independently associated with operative death and perioperative myocardial infarction and improves the ability to predict operative mortality in comparison with preoperative risk scores alone. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/17462392/Prognostic_significance_of_elevated_cardiac_troponin_I_after_heart_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(07)00002-1 DB - PRIME DP - Unbound Medicine ER -