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Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T

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...

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Autores principales: Sharma, Vikram, Zheng, Huili, Candilio, Luciano, Nicholas, Jennifer M., Clayton, Tim, Yellon, Derek M., Bulluck, Heerajnarain, Hausenloy, Derek J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342425/
https://www.ncbi.nlm.nih.gov/pubmed/37445326
http://dx.doi.org/10.3390/jcm12134291
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author Sharma, Vikram
Zheng, Huili
Candilio, Luciano
Nicholas, Jennifer M.
Clayton, Tim
Yellon, Derek M.
Bulluck, Heerajnarain
Hausenloy, Derek J.
author_facet Sharma, Vikram
Zheng, Huili
Candilio, Luciano
Nicholas, Jennifer M.
Clayton, Tim
Yellon, Derek M.
Bulluck, Heerajnarain
Hausenloy, Derek J.
author_sort Sharma, Vikram
collection PubMed
description 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: ≥100 × URL at 6 h; ≥50 × URL at 12 and 24 h; ≥35 × URL at 48 h; and ≥30 × URL at 72 h post-surgery. Elevation in hs-TnT at 24 h ≥ 50 × 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 × 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 ≥50 × URL elevation in hs-TnT at 24 h.
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spelling pubmed-103424252023-07-14 Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T Sharma, Vikram Zheng, Huili Candilio, Luciano Nicholas, Jennifer M. Clayton, Tim Yellon, Derek M. Bulluck, Heerajnarain Hausenloy, Derek J. J Clin Med Article 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: ≥100 × URL at 6 h; ≥50 × URL at 12 and 24 h; ≥35 × URL at 48 h; and ≥30 × URL at 72 h post-surgery. Elevation in hs-TnT at 24 h ≥ 50 × 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 × 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 ≥50 × URL elevation in hs-TnT at 24 h. MDPI 2023-06-26 /pmc/articles/PMC10342425/ /pubmed/37445326 http://dx.doi.org/10.3390/jcm12134291 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sharma, Vikram
Zheng, Huili
Candilio, Luciano
Nicholas, Jennifer M.
Clayton, Tim
Yellon, Derek M.
Bulluck, Heerajnarain
Hausenloy, Derek J.
Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T
title Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T
title_full Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T
title_fullStr Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T
title_full_unstemmed Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T
title_short Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T
title_sort defining peri-operative myocardial injury during cardiac surgery using high-sensitivity troponin t
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342425/
https://www.ncbi.nlm.nih.gov/pubmed/37445326
http://dx.doi.org/10.3390/jcm12134291
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