Risk stratification with troponin I in patients undergoing myocardial revascularization surgery

Perioperative serum troponin I levels are associated with higher risk for atrial fibrillation in patients undergoing coronary artery bypass graft surgery

Atrial fibrillation (AF) remains a frequent complication after coronary artery bypass graft surgery (CABG). We evaluate the association of AF occurrence and serum cardiac troponin I (cTnI) levels in the early postoperative period after CABG. Between April 2009 and January 2010, 95 consecutive patients with sinus rhythm who underwent CABG were evaluated. The patients were divided into two groups according to their postoperative rhythms: sinus rhythm group (SR) and AF group (AF). Demographic, clinical variables, and troponin I were evaluated at the pre- and postoperative times. There were no clinical or demographic differences between the two groups. The postoperative troponin I in the SR group was lower than that in the AF group (0.66 ± 1.62 vs. 2.07 ± 5.01 ng/ml; P = 0.029). Using the receiver operating characteristic curves was found as the best cut-off value to predict AF occurrence at the value of 0.901 ng/ml. Using this value of cTnI, a sensitivity of 60% and a specificity of 87% for AF onset prediction were observed. The cTnI serum levels at the postoperative period after CABG were higher in patients who subsequently developed AF. The cut-off value of 0.901 ng/ml is useful for prediction and preventive therapeutic actions.

Biochemical injury markers and mortality after coronary artery bypass grafting: a systematic review

The strength of the association between cardiac biomarker release and prognosis is uncertain. We performed a systematic literature search to find articles regarding these markers and death after coronary surgical interventions, and evaluated the results with meta-analytic methods. We found 23 articles concerning 29,483 patients that reported the MB fraction of creatine kinase (CK-MB) and troponin T and I. Heterogeneity of existing studies prevented the pooling of the results of troponin studies. The pooled data of the CK-MB studies suggest that after coronary artery bypass grafting, CK-MB release of more than five to eight times the upper limit of the reference range is associated with an increased risk of death during the next 40 months.