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(Circulation. 2006;114:1468-1475.)
© 2006 American Heart Association, Inc.

Cardiovascular Surgery

Relationship Between Postoperative Cardiac Troponin I Levels and Outcome of Cardiac Surgery

Bernard L. Croal, MB, ChB, MD; Graham S. Hillis, MB, ChB, PhD; Patrick H. Gibson, BM, BCh; Mohammed T. Fazal, MB, ChB; Hussein El-Shafei, MB, ChB, MD; George Gibson, MB, ChB; Robert R. Jeffrey, MB, ChB; Keith G. Buchan, MB, ChB; Douglas West, MB, ChB; Brian H. Cuthbertson, MB, ChB, MD

From the Departments of Clinical Biochemistry (B.L.C., M.T.F.), Cardiology (G.S.H., P.H.G.), Cardiac Surgery (K.G.B., H.E.-S., G.G., R.R.J., D.W.), and Health Services Research Unit (B.L.C., B.H.C.), University of Aberdeen and Aberdeen Royal Infirmary, Aberdeen, United Kingdom.

Correspondence to Dr Bernard L. Croal, Department of Clinical Biochemistry, Aberdeen Royal Infirmary, Aberdeen, United Kingdom, AB25 2ZD. E-mail bernie.croal{at}nhs.net

Received November 19, 2005; revision received July 18, 2006; accepted August 4, 2006.

Background— 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.

Methods and Results— 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 µg/L, 95% confidence interval [CI] 1.05 to 1.24, P=0.002), 1 year (OR 1.10 per 10 µg/L, 95% CI 1.03 to 1.18, P=0.006), and 3 years (OR 1.07 per 10 µg/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.

Conclusions— 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.

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CLINICAL PERSPECTIVE

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