PMID- 37445326
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230919
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 12
IP  - 13
DP  - 2023 Jun 26
TI  - Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using 
      High-Sensitivity Troponin T.
LID - 10.3390/jcm12134291 [doi]
LID - 4291
AB  - OBJECTIVE: Cut-offs for high-sensitivity troponin (hs-Tn) elevations to define 
      prognostically significant peri-operative myocardial injury (PMI) in cardiac 
      surgery is not well-established. We evaluated the associations between 
      peri-operative high-sensitivity troponin T (hs-TnT) elevations and 1-year 
      all-cause mortality in patients undergoing cardiac surgery. METHODS: The 
      prognostic significance of baseline hs-TnT and various thresholds for 
      post-operative hs-TnT elevation at different time-points on 1-year all-cause 
      mortality following cardiac surgery were assessed after adjusting for baseline 
      hs-TnT and EuroSCORE in a post-hoc analysis of the ERICCA trial. RESULTS: 1206 
      patients met the inclusion criteria. Baseline elevation in hs-TnT >x1 99th 
      percentile upper reference limit (URL) was significantly associated with 1-year 
      all-cause mortality (adjusted hazard ratio 1.90, 95% confidence interval 
      1.15-3.13). In the subgroup with normal baseline hs-TnT (n = 517), elevation in 
      hs-TnT at all post-operative time points was associated with higher 1-year 
      mortality, reaching statistical significance for elevations above: >/=100 x URL at 
      6 h; >/=50 x URL at 12 and 24 h; >/=35 x URL at 48 h; and >/=30 x URL at 72 h 
      post-surgery. Elevation in hs-TnT at 24 h >/= 50 x URL had the optimal sensitivity 
      and specificity (73% and 75% respectively). When the whole cohort of patients was 
      analysed, including those with abnormal baseline hs-TnT (up to 10 x URL), the 
      same threshold had optimal sensitivity and specificity (66% and 70%). 
      CONCLUSIONS: Both baseline and post-operative hs-TnT elevations are independently 
      associated with 1-year all-cause mortality in patients undergoing cardiac 
      surgery. The optimal threshold to define a prognostically significant PMI in our 
      study was >/=50 x URL elevation in hs-TnT at 24 h.
FAU - Sharma, Vikram
AU  - Sharma V
AD  - Department of Cardiovascular Medicine, University of Iowa, Iowa City, IA 52242, 
      USA.
FAU - Zheng, Huili
AU  - Zheng H
AD  - National Registry of Diseases, Health Promotion Board, Singapore 168937, 
      Singapore.
FAU - Candilio, Luciano
AU  - Candilio L
AUID- ORCID: 0000-0002-1886-0119
AD  - Department of Cardiology, Royal Free Hospital, London NW3 2QG, UK.
FAU - Nicholas, Jennifer M
AU  - Nicholas JM
AUID- ORCID: 0000-0001-6023-0391
AD  - Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene 
      & Tropical Medicine, London WC1E 7HT, UK.
FAU - Clayton, Tim
AU  - Clayton T
AUID- ORCID: 0000-0002-1266-3288
AD  - Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene 
      & Tropical Medicine, London WC1E 7HT, UK.
FAU - Yellon, Derek M
AU  - Yellon DM
AD  - The Hatter Cardiovascular Institute, University College London, London WC1E 6HX, 
      UK.
FAU - Bulluck, Heerajnarain
AU  - Bulluck H
AUID- ORCID: 0000-0002-1985-1783
AD  - Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 
      Leeds LS2 9JT, UK.
AD  - Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS 
      Trust, Leeds LS1 3EX, UK.
FAU - Hausenloy, Derek J
AU  - Hausenloy DJ
AUID- ORCID: 0000-0003-0729-4956
AD  - The Hatter Cardiovascular Institute, University College London, London WC1E 6HX, 
      UK.
AD  - Cardiovascular & Metabolic Disorders Program, Duke-National University of 
      Singapore Medical School, Singapore 169857, Singapore.
AD  - National Heart Research Institute Singapore, National Heart Centre, Singapore 
      169609, Singapore.
AD  - Yong Loo Lin School of Medicine, National University Singapore, Singapore 117597, 
      Singapore.
AD  - Cardiovascular Research Center, College of Medical and Health Sciences, Asia 
      University, Taichung 41354, Taiwan.
LA  - eng
GR  - 09/100/05/National Institute for Health Research/
GR  - MOH-STaR21jun-0003/National Medical Research Council/
GR  - NMRC CG21APR1006/National Medical Research Council/
GR  - NMRC/CG21APRC006/National Medical Research Council/
PT  - Journal Article
DEP - 20230626
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC10342425
OTO - NOTNLM
OT  - coronary artery bypass graft surgery
OT  - high-sensitivity troponin
OT  - mortality
OT  - peri-operative myocardial injury
COIS- The authors declare no conflict of interest.
EDAT- 2023/07/14 13:06
MHDA- 2023/07/14 13:07
PMCR- 2023/06/26
CRDT- 2023/07/14 01:10
PHST- 2023/05/08 00:00 [received]
PHST- 2023/06/11 00:00 [revised]
PHST- 2023/06/21 00:00 [accepted]
PHST- 2023/07/14 13:07 [medline]
PHST- 2023/07/14 13:06 [pubmed]
PHST- 2023/07/14 01:10 [entrez]
PHST- 2023/06/26 00:00 [pmc-release]
AID - jcm12134291 [pii]
AID - jcm-12-04291 [pii]
AID - 10.3390/jcm12134291 [doi]
PST - epublish
SO  - J Clin Med. 2023 Jun 26;12(13):4291. doi: 10.3390/jcm12134291.