High-sensitivity cardiac troponin I after coronary artery bypass grafting for post-operative decision-making
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High-sensitivity cardiac troponin I after coronary artery bypass grafting for post-operative decision-making. / Omran, Hazem; Deutsch, Marcus A; Groezinger, Elena; Zittermann, Armin; Renner, André; Neumann, Johannes T; Westermann, Dirk; Myles, Paul; Ramosaj, Burim; Pauly, Markus; Scholtz, Werner; Hakim-Meibodi, Kavous; Rudolph, Tanja K; Gummert, Jan; Rudolph, Volker.
in: EUR HEART J, Jahrgang 43, Nr. 25, 01.07.2022, S. 2388-2403.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - High-sensitivity cardiac troponin I after coronary artery bypass grafting for post-operative decision-making
AU - Omran, Hazem
AU - Deutsch, Marcus A
AU - Groezinger, Elena
AU - Zittermann, Armin
AU - Renner, André
AU - Neumann, Johannes T
AU - Westermann, Dirk
AU - Myles, Paul
AU - Ramosaj, Burim
AU - Pauly, Markus
AU - Scholtz, Werner
AU - Hakim-Meibodi, Kavous
AU - Rudolph, Tanja K
AU - Gummert, Jan
AU - Rudolph, Volker
PY - 2022/7/1
Y1 - 2022/7/1
N2 - AIMS: Current troponin cut-offs suggested for the post-operative workup of patients following coronary artery bypass graft (CABG) surgery are based on studies using non-high-sensitive troponin assays or are arbitrarily chosen. We aimed to identify an optimal cut-off and timing for a proprietary high-sensitivity cardiac troponin I (hs-cTnI) assay to facilitate post-operative clinical decision-making.METHODS AND RESULTS: We performed a retrospective analysis of all patients undergoing elective isolated CABG at our centre between January 2013 and May 2019. Of 4684 consecutive patients, 161 patients (3.48%) underwent invasive coronary angiography after surgery, of whom 86 patients (53.4%) underwent repeat revascularization. We found an optimal cut-off value for peak hs-cTnI of >13 000 ng/L [>500× the upper reference limit (URL)] to be significantly associated with repeat revascularization within 48 h after surgery, which was internally validated through random repeated sampling with 1000 iterations. The same cut-off also predicted 30-day major adverse cardiovascular events and all-cause mortality after a median follow-up of 3.1 years, which was validated in an external cohort. A decision tree analysis of serial hs-cTnI measurements showed no added benefit of hs-cTnI measurements in patients with electrocardiographic or echocardiographic abnormalities or haemodynamic instability. Likewise, early post-operative hs-cTnI elevations had a low yield for clinical decision-making and only later elevations (at 12-16 h post-operatively) using a threshold of 8000 ng/L (307× URL) were significantly associated with repeat revascularization with an area under the curve of 0.92 (95% confidence interval 0.88-0.95).CONCLUSION: Our data suggest that for hs-cTnI, higher cut-offs than currently recommended should be used in the post-operative management of patients following CABG.
AB - AIMS: Current troponin cut-offs suggested for the post-operative workup of patients following coronary artery bypass graft (CABG) surgery are based on studies using non-high-sensitive troponin assays or are arbitrarily chosen. We aimed to identify an optimal cut-off and timing for a proprietary high-sensitivity cardiac troponin I (hs-cTnI) assay to facilitate post-operative clinical decision-making.METHODS AND RESULTS: We performed a retrospective analysis of all patients undergoing elective isolated CABG at our centre between January 2013 and May 2019. Of 4684 consecutive patients, 161 patients (3.48%) underwent invasive coronary angiography after surgery, of whom 86 patients (53.4%) underwent repeat revascularization. We found an optimal cut-off value for peak hs-cTnI of >13 000 ng/L [>500× the upper reference limit (URL)] to be significantly associated with repeat revascularization within 48 h after surgery, which was internally validated through random repeated sampling with 1000 iterations. The same cut-off also predicted 30-day major adverse cardiovascular events and all-cause mortality after a median follow-up of 3.1 years, which was validated in an external cohort. A decision tree analysis of serial hs-cTnI measurements showed no added benefit of hs-cTnI measurements in patients with electrocardiographic or echocardiographic abnormalities or haemodynamic instability. Likewise, early post-operative hs-cTnI elevations had a low yield for clinical decision-making and only later elevations (at 12-16 h post-operatively) using a threshold of 8000 ng/L (307× URL) were significantly associated with repeat revascularization with an area under the curve of 0.92 (95% confidence interval 0.88-0.95).CONCLUSION: Our data suggest that for hs-cTnI, higher cut-offs than currently recommended should be used in the post-operative management of patients following CABG.
U2 - 10.1093/eurheartj/ehab918
DO - 10.1093/eurheartj/ehab918
M3 - SCORING: Journal article
VL - 43
SP - 2388
EP - 2403
JO - EUR HEART J
JF - EUR HEART J
SN - 0195-668X
IS - 25
ER -