Troponin is superior to electrocardiogram and creatinine kinase MB for predicting clinically significant myocardial injury after coronary artery bypass grafting

Aims Cardiac biomarkers are routinely elevated after uncomplicated cardiac surgery to levels considered diagnostic of myocardial infarction in ambulatory populations. We investigated the diagnostic power of electrocardiogram (ECG) and cardiac biomarker criteria to predict clinically relevant myocard...

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Bibliographic Details
Published in:European heart journal 2009-07, Vol.30 (13), p.1574-1583
Main Authors: Muehlschlegel, Jochen D., Perry, Tjörvi E., Liu, Kuang-Yu, Nascimben, Luigino, Fox, Amanda A., Collard, Charles D., Avery, Edwin G., Aranki, Sary F., D’Ambra, Michael N., Shernan, Stanton K., Body, Simon C.
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Biomarkers - blood
Cardiology. Vascular system
Cardiopulmonary bypass
Clinical Enzyme Tests
Clinical Research
Coronary Artery Bypass - adverse effects
Coronary heart disease
Creatine Kinase, MB Form - blood
Electrocardiography
Electrocardiography - methods
Enzymes
Epidemiologic Methods
Female
Heart
Humans
Length of Stay - statistics & numerical data
Male
Medical sciences
Middle Aged
Mortality
Myocardial Infarction - diagnosis
Myocardial Infarction - etiology
Myocarditis. Cardiomyopathies
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Troponin
Troponin I - blood
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Summary:Aims Cardiac biomarkers are routinely elevated after uncomplicated cardiac surgery to levels considered diagnostic of myocardial infarction in ambulatory populations. We investigated the diagnostic power of electrocardiogram (ECG) and cardiac biomarker criteria to predict clinically relevant myocardial injury using benchmarks of mortality and increased hospital length of stay (HLOS) in patients undergoing coronary artery bypass graft (CABG) surgery. Methods and results Perioperative ECGs, creatinine kinase MB fraction, and cardiac troponin I (cTnI) were assessed in 545 primary CABG patients. None of the ECG criteria for myocardial injury predicted mortality or HLOS. However, post-operative day (POD) 1 cTnI levels independently predicted 5-year mortality (hazard ratio = 1.42; 95% CI 1.14–1.76 for each 10 µg/L increase; P = 0.009), while adjusting for baseline demographic characteristics and perioperative risk factors. Moreover, cTnI was the only biomarker that significantly improved the prediction of 5-year mortality estimated by the logistic Euroscore (P = 0.02). Furthermore, the predictive value of cTnI for 5-year mortality was replicated in a separately collected cohort of 1031 CABG patients using cardiac troponin T. Conclusion Electrocardiogram diagnosis of post-operative myocardial injury after CABG does not independently predict an increased risk of 5-year mortality or HLOS. Conversely, cTnI is independently associated with an increased risk of mortality and prolonged HLOS.
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehp134