Preoperative troponin levels and outcomes of coronary surgery following myocardial infarction

Prognostic Value of Cardiac Biomarkers in Patients Undergoing On-Pump Coronary Artery Bypass Grafting: A Cohort Study in An Iranian Population

Background

The predictive value of creatine kinase-myocardial band (CK-MB) and high-sensitivity troponin T (hs-TnT) for adverse outcomes in coronary artery bypass grafting (CABG) has been well established in previous studies. However, most of these investigations have focused on perioperative complications. The present study assessed the preoperative and postoperative prognostic value of hs-TnT and CK-MB in individuals undergoing on-pump CABG.

Methods

This cohort study included patients who underwent isolated on-pump CABG at a tertiary hospital, Tehran Heart Center, between November 2018 and March 2021. We evaluated the associations of preoperative and postoperative hs-TnT and CK-MB levels with the incidence of major adverse cardiovascular events (MACE) within 1 year after surgery.

Results

Of the 3,188 participants, 231 (7.2%) experienced MACE. Factors associated with a higher incidence of MACE included older age, diabetes mellitus, history of peripheral vascular disease, lower left ventricular ejection fraction, and the occurrence of acute kidney injury after surgery. The adjusted hazard ratios (HRs) for the association between hs-TnT levels and 1-year MACE were 1.17 (95% confidence interval [CI], 1.07-1.29; p<0.001) for preoperative levels, 1.22 (95% CI, 1.02-1.47; p=0.044) at 8 hours post-surgery, and 1.38 (95% CI, 1.17-1.62; p<0.001) at 24 hours post-surgery. CK-MB levels at 8 hours (HR, 1.05; 95% CI, 1.01-1.10; p=0.023) and 24 hours (HR, 1.07; 95% CI, 1.04-1.10; p<0.001) after surgery were also associated with adverse events.

Conclusion

Preoperative and postoperative serum levels of hs-TnT and CK-MB may be considered significant predictors of MACE within 1 year after on-pump CABG.