Year : 2009  |  Volume : 12  |  Issue : 1  |  Page : 86--88

The value of postoperative troponin levels in predicting long-term mortality after coronary artery bypass surgery


Petros Tzimas1, Haralampos J Milionis2, Helen Arnaoutoglou1, Kallirroi Kalantzi3, Elias Karfis4, Panagiotis Korantzopoulos3, Kostantinos Pappas3, Georgios Drossos4, Georgios Papadopoulos1,  
1 Department of Anesthesiology, University of Ioannina, School of Medicine, 45110 Loannina, Greece
2 Department of Internal Medicine, University of Ioannina, School of Medicine, 45110 Loannina, Greece
3 Department of Cardiology, University of Ioannina, School of Medicine, 45110 Loannina, Greece
4 Department of Cardiothoracic Surgery, University of Ioannina, School of Medicine, 45110 Loannina, Greece

Correspondence Address:
Panagiotis Korantzopoulos
Department of Cardiology, University of Ioannina, Medical School, 45110 Loannina
Greece




How to cite this article:
Tzimas P, Milionis HJ, Arnaoutoglou H, Kalantzi K, Karfis E, Korantzopoulos P, Pappas K, Drossos G, Papadopoulos G. The value of postoperative troponin levels in predicting long-term mortality after coronary artery bypass surgery.Ann Card Anaesth 2009;12:86-88


How to cite this URL:
Tzimas P, Milionis HJ, Arnaoutoglou H, Kalantzi K, Karfis E, Korantzopoulos P, Pappas K, Drossos G, Papadopoulos G. The value of postoperative troponin levels in predicting long-term mortality after coronary artery bypass surgery. Ann Card Anaesth [serial online] 2009 [cited 2022 May 21 ];12:86-88
Available from: https://www.annals.in/text.asp?2009/12/1/86/45023


Full Text

The Editor,

Despite advances in techniques and devices, postoperative complications after coronary artery bypass grafting (CABG) surgery represent a significant problem that adversely affect both short- and long-term prognosis. There seems to be a continuous need for the establishment of markers with sufficient predictive value, especially with regard to long-term prognosis. Several risk scores such as the commonly used EuroSCORE have been developed aiming at the prediction of perioperative mortality. [1] However, these scores are based only on the assessment of preoperative clinical variables, not taking into account perioperative and postoperative complications. Thus, there is an increasing interest for the development of novel easily applied markers that have the potential to enhance our predictive ability.

Biochemical markers of myocardial injury can be easily determined during the early postoperative period. Postoperative troponin elevation is a common phenomenon with several potential mechanisms that often leads to diagnostic confusion. Regardless of the underlying cause, it reflects myocardial damage. Cardiac troponin I (cTnI) represents a sensitive and specific marker of myocardial damage in various conditions including the postoperative setting. [2] However, its value in predicting long-term mortality after CABG, the determination of the threshold level, and the best timing for the assessment have not been well-studied, while inconsistent results have been published in the literature. [3],[4],[5],[6],[7],[8] We investigated the value and the threshold level of postoperative cTnI in predicting long-term mortality after CABG surgery.

Forty-one consecutive patients who underwent elective CABG were prospectively studied. Exclusion criteria included emergency surgery, re-operative procedures, concomitant valve repair or replacement, and preoperative chronic kidney disease (creatinine clearance P = 0.018). A threshold value of 13.4 ng/ml was highly associated with long-term mortality with a sensitivity of 100% and a specificity of 76%. The clinical characteristics of the patients when divided into two groups according to the threshold value of cTnI are presented in [Table 2]. Patients at higher risk according to cTnI levels (≥13 ng/ml) had more frequently left main disease needed more frequently IABP support and were hospitalized in the intensive care unit for longer periods [Table 2].

According to our findings, troponin levels after CABG surgery could be used to predict increased long-term risk for death. In line with previous studies, our study supports the value of postoperative cTnI in predicting long-term mortality, while it reinforces the view that a cut-off value in the range of 13 ng/ml measured 24 h after surgery is possibly the most acceptable threshold level. [3] The value of cTnI measurement may be additive to other well-established clinical tools such as the EuroSCORE. Obtaining these measurements in the peri- and post-operative period seems to be of clinical significance in identifying high-risk CABG patients. More studies are needed to further clarify the exact role of postoperative troponin measurement in mortality prediction.

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