| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Division of Cardiac and Vascular Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Suite H410, University of Toronto, Toronto, Ontario, Canada M4N 3M5
(Email: stephen.fremes{at}sunnybrook.ca).
Lurati Buse and colleagues [1] aimed to ascertain the value of postoperative troponin T (TNT) as a predictor of mid-term (ie, 1-year) mortality or major adverse cardiac events, independently and in combination with the logistic EuroSCORE. They concluded that TNT was a strong independent predictor of 1-year outcomes, and that adding TNT to EuroSCORE improved the prognostic value compared with the EuroSCORE alone.
Although the EuroSCORE was originally validated to calculate operative mortality, it has been shown to be useful in predicting late events, as it is composed of important preoperative patient, cardiac and operative risk factors [2]. The prognostic value of perioperative adverse events on late events is better established [3]. Although CKmB thresholds, moreso than TNT, have been well described to predict both early and late events [4], Lurati Buse and colleagues [1] found TNT to be a better predictor of 1-year mortality than CK-mB. Thus, as TNT is a sensitive and readily available marker of postoperative myocardial infarction, its addition to the EuroSCORE has validity for improving prognostic value for mid-term and late-term events.
Lurati Buse and colleagues [1] reviewed on-pump patients (excluding circulatory arrest and trauma patients) irrespective of preoperative TNT. Although it was not statistically significant, patients who experienced mortality or major adverse cardiac events (MACE) included 18.5% who had a recent preoperative myocardial infarction versus 14.5% in the group without an event at 1 year. Although these patients have been excluded in previous studies, the results of Lurati Buse and colleagues [1] are still consistent with those in the literature, with the predictive postoperative TNT cut-off of 0.9ug/L [5].
Other established, validated risk calculators in adult cardiac surgery include The Society for Thoracic Surgeons (STS) risk calculator and the Parsonnet score. Both of these methods use preoperative and intraoperative factors to predict operative mortality. The STS score has a published predictive value (c-statistic/receiver-operator-curve [ROC] area-under-the-curve [AUC]) of 0.75 for combined coronary surgery plus valve surgery and 0.79 for isolated coronary surgery mortality or isolated valve surgery mortality, whereas the published predictive value of the Parsonnet score ranges from 0.64 to 0.74 [6, 7]. Although the logistic EuroSCORE was found to have a predictive value of 0.71 for mortality in this study, combining it with TNT increased it to 0.8, slightly better than other established risk calculators.
The authors should be congratulated for their rigorous analysis of an important topic, the conclusions of which add to the science of mid-term mortality risk calculation in cardiac surgery.
 |
References |
|---|
 Top References |
|---|
Related Article
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
