Document Detail


Prognostic significance of elevated cardiac troponin I after heart surgery.
MedLine Citation:
PMID:  17462392     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiac troponin I (cTnI) measured after heart surgery has been associated with operative mortality. We sought to determine whether measuring cTnI after heart surgery provides additional prognostic information beyond that provided by validated preoperative risk scores, the Veterans Affairs (VA) risk score and the European System for Cardiac Operative Risk Evaluation (EuroSCORE). METHODS: We retrospectively collected cTnI levels measured 24 hours after surgery in 1,186 patients who underwent coronary artery bypass graft surgery (n = 696) or valve surgery (n = 490). The outcomes were operative death and perioperative myocardial infarction. The ability of the cTnI and the risk scores to discriminate patients who did or did not have the study outcomes was assessed by the area under the receiver operating curve (c-index). RESULTS: Mean age was 66 +/- 10 years. Median cTnI was 38 ng/mL after valve surgery versus 18 ng/mL after coronary artery bypass graft surgery (p < 0.0001). There were 51 operative deaths (4.3%) and 142 perioperative myocardial infarctions (12%). For every 50 ng/mL increase in cTnI, the odds of operative death increased by 40% (odds ratio, 1.4; 95% confidence interval: 1.2 to 1.6) after coronary artery bypass graft surgery and by 30% (odds ratio, 1.3; 95% confidence interval: 1.1 to 1.5) after valve surgery. Cardiac troponin I was a significant independent correlate of perioperative myocardial infarction and death (p < 0.0001) with a c-index of 0.70 for death. Addition of cTnI improved the c-indexes of the risk scores for predicting death (from 0.75 to 0.79 for the VA risk score; p = 0.1; and from 0.69 to 0.77 for the EuroSCORE; p = 0.005). CONCLUSIONS: Postoperative cTnI measured 24 hours after heart surgery is independently associated with operative death and perioperative myocardial infarction and improves the ability to predict operative mortality in comparison with preoperative risk scores alone.
Authors:
A Selcuk Adabag; Thomas Rector; Salima Mithani; John Harmala; Herbert B Ward; Rosemary F Kelly; John T Nguyen; Edward O McFalls; Hanna E Bloomfield
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  83     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-27     Completed Date:  2007-05-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1744-50     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Veterans Affairs Medical Center and the University of Minnesota, Minneapolis, Minnesota 55417, USA. adaba001@umn.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Biological Markers / blood
Cardiac Surgical Procedures / adverse effects*,  mortality*
Female
Humans
Male
Middle Aged
Myocardial Infarction / blood*,  etiology
Predictive Value of Tests
Prognosis
Retrospective Studies
Risk Factors
Troponin I / blood*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Troponin I

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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