This Article Full Text Full Text (PDF) All Versions of this Article: 114/14/1468    most recent CIRCULATIONAHA.105.602370v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Croal, B. L. Articles by Cuthbertson, B. H. Search for Related Content PubMed PubMed Citation Articles by Croal, B. L. Articles by Cuthbertson, B. H. Related Collections Chronic ischemic heart disease CV surgery: coronary artery disease Related Article

(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.

---

 

CLINICAL PERSPECTIVE

Related Article:

Issue Highlights
Circulation 2006 114: 1447. [Full Text]

This article has been cited by other articles:

				N. Nesher, A. A. Alghamdi, S. K. Singh, J. Y. Sever, G. T. Christakis, B. S. Goldman, G. N. Cohen, F. Moussa, and S. E. Fremes Troponin after Cardiac Surgery: A Predictor or a Phenomenon? Ann. Thorac. Surg., April 1, 2008; 85(4): 1348 - 1354. [Abstract] [Full Text] [PDF]

				NACB WRITING GROUP MEMBERS, A. H.B. Wu, A. S. Jaffe, F. S. Apple, R. L. Jesse, G. L. Francis, D. A. Morrow, L. K. Newby, J. Ravkilde, W.H. W. Tang, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Use of Cardiac Troponin and B-Type Natriuretic Peptide or N-Terminal proB-Type Natriuretic Peptide for Etiologies Other than Acute Coronary Syndromes and Heart Failure Clin. Chem., December 1, 2007; 53(12): 2086 - 2096. [Abstract] [Full Text] [PDF]

				K. Thygesen, J. S. Alpert, H. D. White, and on behalf of the Joint ESC/ACCF/AHA/WHF Task Force Universal Definition of Myocardial Infarction J. Am. Coll. Cardiol., November 27, 2007; 50(22): 2173 - 2195. [Full Text] [PDF]

				K. Thygesen, J. S. Alpert, H. D. White, on behalf of the Joint ESC/ACCF/AHA/WHF Task Force, TASK FORCE MEMBERS: Chairpersons: Kristian Thygese, Biomarker Group: Allan S. Jaffe, Coordinator (USA), ECG Group: Bernard Chaitman, Co-ordinator (USA), P, Imaging Group: Richard Underwood, Coordinator (UK), Intervention Group: Jean-Pierre Bassand, Co-ordina, Clinical Investigation Group: Paul W. Armstrong, C, et al. Universal Definition of Myocardial Infarction Circulation, November 27, 2007; 116(22): 2634 - 2653. [Full Text] [PDF]

				Task Force Members, K. Thygesen, J. S. Alpert, H. D. White, Biomarker Group, A. S. Jaffe, F. S. Apple, M. Galvani, H. A. Katus, L. K. Newby, et al. Universal definition of myocardial infarction: Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction Eur. Heart J., October 2, 2007; 28(20): 2525 - 2538. [Full Text] [PDF]

				A. S. Adabag, T. Rector, S. Mithani, J. Harmala, H. B. Ward, R. F. Kelly, J. T. Nguyen, E. O. McFalls, and H. E. Bloomfield Prognostic Significance of Elevated Cardiac Troponin I After Heart Surgery Ann. Thorac. Surg., May 1, 2007; 83(5): 1744 - 1750. [Abstract] [Full Text] [PDF]