Cardiac Troponin-T is an important predictor of Mortality Following Cardiac Surgery

• Published in: Journal of critical care
• Main Authors: Mokhtar, Ahmed T, Begum, Jahanara, Buth, Karen J, Legare, Jean-Francois
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Critical Care; NYHA; Cardiac Troponin levels; MHC; New York Heart Association; Myocardial Infarction; troponin; Maritime Heart Centre; Coronary artery bypass grafting; Queen Elizabeth II Health Sciences Centre; cardiac surgery; cTnT; myocardial ischemia; Chronic obstructive pulmonary disease; CABG; MI; COPD; QEII HSC
• ISSN: 0883-9441
• DOI: 10.1016/j.jcrc.2016.10.011

Abstract Purpose Serum troponin (cTnT) levels, a commonly measured biomarker of myocardial injury, has rarely been considered in risk models following cardiac surgery. Materials and Methods Retrospectively study of patients undergoing any cardiac surgery between 2004 and 2012. Patients with a history of recent myocardial injury (<21 days) were excluded. The minimum p-value approach was used to determine categories of peak cTnT associated with in-hospital death. A multivariable analysis was performed to identify independent predictors of mortality. Results A total of 5318 patients without evidence of preoperative ischemia underwent a number of cardiac surgical interventions ranging from isolated coronary revascularization (CABG) to combined valve CABG. The unadjusted in-hospital mortality rate was 3.3% (n = 175 patients). Four categories of peak cTnT were identified using the minimum p-value approach: ≤ 0.6 ng/ml, 0.7–1.9 ng/ml, 2.0–3.1 ng/ml and >3.1 ng/ml with unadjusted mortality rates of 1.0%, 3.6%, 10.1% and 33.1%, respectively. Multivariate logistic regression demonstrated that all peak cTnT levels >0.6 ng/ml were independent predictors of in-hospital mortality in a dose-dependent manner. Conclusions We demonstrate that in patients without preoperative myocardial ischemia the demonstration of myocardial injury (>0.6 ng/ml) in the post-operative period is highly predictive of in-hospital death.