HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nahum Nesher Abdullah A. Alghamdi Steve K. Singh George T. Christakis Bernard S. Goldman Gideon N. Cohen Fuad Moussa Stephen E. Fremes Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nesher, N. Articles by Fremes, S. E. Search for Related Content PubMed PubMed Citation Articles by Nesher, N. Articles by Fremes, S. E. Related Collections Cardiac - other Related Article

---

Original Articles: Adult Cardiac

Troponin after Cardiac Surgery: A Predictor or a Phenomenon?

Division of Cardiac and Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Accepted for publication December 31, 2007.

^_* Address correspondence to Dr Nesher, 2075 Bayview Ave, H410, Toronto, Ontario, M4N 3M5, Canada (Email: nachumnesher{at}yahoo.com).

Background: Increased cardiac troponin is observed after virtually every cardiac operation, indicating perioperative myocardial injury. The clinical significance of this elevation is controversial. This study aimed to correlate postoperative troponin levels with major adverse cardiac events (MACE).

Methods: The study included 1918 consecutive patients undergoing adult cardiac operations, including 1515 isolated coronary procedures, 229 valvular operations, and 174 combined coronary/valve procedures. Peak troponin T (normal value < 0.1 µg/L) was measured at less than 24 hours postoperatively. Excluded were 506 patients with a recent myocardial infarction (< 30-days of operation). The primary outcome was a composite of death, electrocardiogram-defined infarction, and low output syndrome (MACE).

Results: Mortality rates were 1.4%, 6.1%, and 7% in the coronary bypass, valve, and combined groups, respectively (p < 0.001). The rates of MACE were 17%, 35%, and 44% (p < 0.0001), and mean troponin T levels were 0.9 ± 1.5, 1.2 ± 2.9, and 1.3 ± 1.2 µg/L (p < 0.001), in the coronary bypass, valve, and combined groups, respectively. All patients were divided into quintiles based on their peak postoperative troponin level (Q1, 0.0 to 0.39; Q2, 0.4 to 0.59; Q3, 0.6 to 0.79; Q4, 0.8 to 1.29; and Q5, > 1.3 µg/L). Adverse outcomes were similar and stable in the lower quintiles. A stepwise increase in adverse outcomes was observed in the higher quintiles. Receiver operating characteristic curve analysis revealed a troponin cutoff of 0.8 µg/L was the most discriminatory for MACE (area under the curve, 0.7). Multivariable analyses showed a troponin value of more than 0.8 µg/L was independently associated with MACE.

Conclusions: Moderate elevations in troponin are common after cardiac operations; troponin is a well-described predictor of outcomes. Troponin levels exceeding 0.8 µg/L are associated with increased MACE in patients without a history of preoperative myocardial infarction within 30 days of operation.

Related Article

Invited Commentary

Valluvan Jeevanandam
Ann. Thorac. Surg. 2008 85: 1354. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				L. Petaja, M. Salmenpera, K. Pulkki, and V. Pettila Biochemical Injury Markers and Mortality After Coronary Artery Bypass Grafting: A Systematic Review. Ann. Thorac. Surg., June 1, 2009; 87(6): 1981 - 1992.e3. [Abstract] [Full Text] [PDF]

				R. A. Fowler, N. K. J. Adhikari, D. C. Scales, W. L. Lee, and G. D. Rubenfeld Update in Critical Care 2008 Am. J. Respir. Crit. Care Med., May 1, 2009; 179(9): 743 - 758. [Full Text] [PDF]

				O. Assar, J. Bagheri, M. H. Mandegar, and F. Roshanali Time of Measurement of Troponin is Essential When We Think About Prediction or Phenomena Ann. Thorac. Surg., November 1, 2008; 86(5): 1721 - 1721. [Full Text] [PDF]

				V. Jeevanandam Invited Commentary Ann. Thorac. Surg., April 1, 2008; 85(4): 1354 - 1354. [Full Text] [PDF]