Early troponin T and prediction of potentially correctable in-hospital complications after coronary artery bypass grafting surgery

Göber, Volkhard; Hohl, Andreas; Gahl, Brigitta; Dick, Florian; Eigenmann, Verena; Carrel, Thierry P.; Tevaearai, Hendrik T. (2013). Early troponin T and prediction of potentially correctable in-hospital complications after coronary artery bypass grafting surgery. PLoS ONE, 8(9), e74241. Public Library of Science 10.1371/journal.pone.0074241

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BACKGROUND Peak levels of troponin T (TnT) reliably predict morbidity and mortality after cardiac surgery. However, the therapeutic window to manage CABG-related in-hospital complications may close before the peak is reached. We investigated whether early TnT levels correlate as well with complications after coronary artery bypass grafting (CABG) surgery. METHODS A 12 month consecutive series of patients undergoing elective isolated CABG procedures (mini-extra-corporeal circuit, Cardioplegic arrest) was analyzed. Logistic regression modeling was used to investigate whether TnT levels 6 to 8 hours after surgery were independently associated with in-hospital complications (either post-operative myocardial infarction, stroke, new-onset renal insufficiency, intensive care unit (ICU) readmission, prolonged ICU stay (>48 hours), prolonged need for vasopressors (>24 hours), resuscitation or death). RESULTS A total of 290 patients, including 36 patients with complications, was analyzed. Early TnT levels (odds ratio (OR): 6.8, 95% confidence interval (CI): 2.2-21.4, P=.001), logistic EuroSCORE (OR: 1.2, 95%CI: 1.0-1.3, P=.007) and the need for vasopressors during the first 6 postoperative hours (OR: 2.7, 95%CI: 1.0-7.1, P=.05) were independently associated with the risk of complications. With consideration of vasopressor use during the first 6 postoperative hours, the sum of specificity (0.958) and sensitivity (0.417) of TnT for subsequent complications was highest at a TnT cut-off value of 0.8 ng/mL. CONCLUSION Early TnT levels may be useful to guide ICU management of CABG patients. They predict clinically relevant complications within a potential therapeutic window, particularly in patients requiring vasopressors during the first postoperative hours, although with only moderate sensitivity.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Göber, Volkhard; Gahl, Brigitta; Dick, Florian; Eigenmann, Verena; Carrel, Thierry and Tevaearai, Hendrik

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1932-6203

Publisher:

Public Library of Science

Language:

English

Submitter:

Laura Seidel

Date Deposited:

17 Apr 2014 11:18

Last Modified:

14 Dec 2014 05:06

Publisher DOI:

10.1371/journal.pone.0074241

PubMed ID:

24040214

BORIS DOI:

10.7892/boris.40978

URI:

https://boris.unibe.ch/id/eprint/40978

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