Relationship between postoperative cardiac troponin I levels and outcome of cardiac surgery

• Published in: Circulation (New York, N.Y.) N.Y.), 2006-10, Vol.114 (14), p.1468-1475
• Main Authors: CROAL, Bernard L, HILLIS, Graham S, GIBSON, Patrick H, FAZAL, Mohammed T, EL-SHAFEI, Hussein, GIBSON, George, JEFFREY, Robert R, BUCHAN, Keith G, WEST, Douglas, CUTHBERTSON, Brian H
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiac Surgical Procedures - mortality; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart; Heart Diseases - congenital; Heart Diseases - mortality; Heart Diseases - surgery; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - surgery; Predictive Value of Tests; Prognosis; Retrospective Studies; Single-Blind Method; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Troponin I - blood; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circulationaha.105.602370

Cardiac surgery may be associated with significant perioperative and postoperative morbidity and mortality. Underlying pathology, surgical technique, and postoperative complications may all influence outcome. These factors may be reflected as a rise in postoperative troponin levels. Interpretation of troponin levels in this setting may therefore be complex. This study assessed the prognostic significance of such measurements, taking into account potential confounding variables. One-thousand three hundred sixty-five patients undergoing cardiac surgery underwent measurement of cardiac troponin I (cTnI) at 2 and 24 hours after surgery. The relationship of these measurements to subsequent mortality was established. After taking into account all other variables, cTnI levels measured at 24 hours were independently predictive of mortality at 30 days (odds ratio [OR] 1.14 per 10 microg/L, 95% confidence interval [CI] 1.05 to 1.24, P=0.002), 1 year (OR 1.10 per 10 microg/L, 95% CI 1.03 to 1.18, P=0.006), and 3 years (OR 1.07 per 10 microg/L, 95% CI 1.00 to 1.15, P=0.04). Cardiac TnI levels in the highest quartile at 24 hours were associated with a particularly poor outcome. cTnI levels measured 24 hours after cardiac surgery predict short-, medium-, and long-term mortality and remain independently predictive when adjusted for all other potentially confounding variables, including operation complexity.