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Evidence-based Laboratory Medicine and Test Utilization |
1 Johns Hopkins University, Department of Cardiology, Baltimore, MD. Medizinische Universität zu Lübeck, Departments of2
Cardiothoracic Surgery and 3
Cardiology, Lübeck, Germany.
4 Medizinische Universitätsklinik Heidelberg, Department of Cardiology, Heidelberg, Germany.
aAddress correspondence to this author at: Medizinische Universitätsklinik Heidelberg, Abteilung für Innere Medizin III, Bergheimer Strasse 58, 69115 Heidelberg, Germany. Fax 49-6221-56-5516; e-mail hugo_katus{at}med.uni-heidelberg.de.
Background: Increased cardiac troponins in blood are observed after virtually every open heart surgery, indicating perioperative myocardial cell injury. We sought to determine the optimum time point for blood sampling and the respective cutoff value of cardiac troponin T (cTnT) for risk assessment in patients undergoing cardiac surgery.
Methods: In a series of 204 patients undergoing scheduled open heart surgery, mainly for coronary artery bypass grafting (n = 132) or valve repair (n = 27), cTnT concentrations were measured before and 4 and 8 h after cross-clamping and then daily for 7 days. Individual risk was assessed by use of the Cleveland Clinic Foundation Risk score and intraoperative risk indicators such as duration of cardiopulmonary bypass, cross-clamping, and perioperative release of cardiac markers. Patients were followed for 28 months.
Results: Cardiac mortality, all-cause mortality rates, and rates of nonfatal acute myocardial infarction (AMI) at 28 months were 6.9%, 8.8%, and 6.8%, respectively. cTnT was higher in patients with Q-wave AMI or postoperative heart failure requiring inotropic support, and in nonsurvivors. The ROC curve revealed a cTnT 
0.46 µg/L at 48 h as the optimum discriminator for long-term cardiac mortality. Stepwise logistic regression identified higher Cleveland Clinic Risk Score [odds ratio (OR) = 2.6 per point], cross-clamp time >65 min (OR = 6.6), and cTnT (OR = 4.9) as significant and independent predictors of long-term cardiac mortality.
Conclusions: A single postoperative cTnT measurement can be used to estimate myocardial cell injury that impacts long-term survival after open heart surgery. It adds independently to established risk indicators.
The following articles in journals at HighWire Press have cited this article:
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  C. Neuhauser, V. Preiss, M.-K. Feurer, M. Muller, S. Scholz, M. Kwapisz, M. Mogk, and I. D. Welters Comparison of S-(+)-ketamine- with sufentanil-based anaesthesia for elective coronary artery bypass graft surgery: effect on troponin T levels Br. J. Anaesth., June 1, 2008; 100(6): 765 - 771. [Abstract] [Full Text] [PDF]
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L. Siracusano, V. Girasole, V. Piriou, and J. Mantz Sevoflurane and cardioprotection Br. J. Anaesth., February 1, 2008; 100(2): 278 - 279. [Full Text] [PDF]
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A. S. Adabag, T. Rector, S. Mithani, J. Harmala, H. B. Ward, R. F. Kelly, J. T. Nguyen, E. O. McFalls, and H. E. Bloomfield Prognostic Significance of Elevated Cardiac Troponin I After Heart Surgery Ann. Thorac. Surg., May 1, 2007; 83(5): 1744 - 1750. [Abstract] [Full Text] [PDF]
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A. Kulik, F. D. Rubens, D. Gunning, M. E. Bourke, T. G. Mesana, and M. Ruel Radial Artery Graft Treatment With Phenoxybenzamine is Clinically Safe and May Reduce Perioperative Myocardial Injury Ann. Thorac. Surg., February 1, 2007; 83(2): 502 - 509. [Abstract] [Full Text] [PDF]
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 B. L. Croal, G. S. Hillis, P. H. Gibson, M. T. Fazal, H. El-Shafei, G. Gibson, R. R. Jeffrey, K. G. Buchan, D. West, and B. H. Cuthbertson Relationship Between Postoperative Cardiac Troponin I Levels and Outcome of Cardiac Surgery Circulation, October 3, 2006; 114(14): 1468 - 1475. [Abstract] [Full Text] [PDF]
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M. Thielmann, P. Massoudy, M. Neuhauser, K. Tsagakis, G. Marggraf, M. Kamler, K. Mann, R. Erbel, and H. Jakob Prognostic Value of Preoperative Cardiac Troponin I in Patients Undergoing Emergency Coronary Artery Bypass Surgery With Non-ST-Elevation or ST-Elevation Acute Coronary Syndromes Circulation, July 4, 2006; 114(1_suppl): I-448 - I-453. [Abstract] [Full Text] [PDF]
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 S. Korff, H. A Katus, and E. Giannitsis Differential diagnosis of elevated troponins. Heart, July 1, 2006; 92(7): 987 - 993. [Full Text] [PDF]
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 I. Kirkeby-Garstad, U. Wisloff, E. Skogvoll, T. Stolen, A.-E. Tjonna, R. Stenseth, and O. F. Sellevold The marked reduction in mixed venous oxygen saturation during early mobilization after cardiac surgery: the effect of posture or exercise? Anesth. Analg., June 1, 2006; 102(6): 1609 - 1616. [Abstract] [Full Text] [PDF]
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 W. Lim, D. J. Cook, L. E. Griffith, M. A. Crowther, and P. J. Devereaux Elevated Cardiac Troponin Levels in Critically Ill Patients: Prevalence, Incidence, and Outcomes Am. J. Crit. Care., May 1, 2006; 15(3): 280 - 288. [Abstract] [Full Text] [PDF]
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 L. Babuin and A. S. Jaffe Troponin: the biomarker of choice for the detection of cardiac injury Can. Med. Assoc. J., November 8, 2005; 173(10): 1191 - 1202. [Abstract] [Full Text] [PDF]
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 M. Thielmann, P. Massoudy, M. Neuhauser, S. Knipp, M. Kamler, J. Piotrowski, K. Mann, and H. Jakob Prognostic Value of Preoperative Cardiac Troponin I in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Artery Bypass Surgery Chest, November 1, 2005; 128(5): 3526 - 3536. [Abstract] [Full Text] [PDF]
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A. Zangrillo, G. Crescenzi, G. Landoni, S. Benussi, M. Crivellari, F. Pappalardo, E. Dorigo, C. Pappone, and O. Alfieri The Effect of Concomitant Radiofrequency Ablation and Surgical Technique (Repair Versus Replacement) on Release of Cardiac Biomarkers During Mitral Valve Surgery Anesth. Analg., July 1, 2005; 101(1): 24 - 29. [Abstract] [Full Text] [PDF]
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 M. Thielmann, P. Massoudy, M. Neuhauser, S. Knipp, M. Kamler, G. Marggraf, J. Piotrowski, and H. Jakob Risk stratification with cardiac troponin I in patients undergoing elective coronary artery bypass surgery Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 861 - 869. [Abstract] [Full Text] [PDF]
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