High sensitivity troponin-I threshold to predict perioperative myocardial infarction

Autor: Tom Friedman, Dror B. Leviner, Veronica Chan, Bobby Yanagawa, Ady Orbach, Abd El Haleem Natour, Anastasia Weis, Erez Sharoni, Gil Bolotin
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Journal of Cardiothoracic Surgery, Vol 18, Iss 1, Pp 1-8 (2023)
Druh dokumentu: article
ISSN: 1749-8090
DOI: 10.1186/s13019-023-02323-0
Popis: Abstract Background High-sensitivity Troponin I (hs-cTnI) has largely replaced conventional troponin assays in an effort to improve detection of myocardial infarction. However, the mean displacement of hs-cTnI following coronary artery bypass graft (CABG) and the optimal threshold to detect perioperative myocardial infarction (MI) is unclear. Our objective is to describe mean hs-cTnI values at 6–12 h post-CABG and to determine the highest specificity while maintaining 100% sensitivity hs-cTnI cut-off values for diagnosis of perioperative or type-5 MI. Methods Between 2016 and 2018, 374 patients underwent non-emergent, isolated CABG. Pre-operative and 6 h post-operative hs-cTnI values were recorded as well as ECG, echocardiographic and angiographic data. Results Of 374 patients, 151 (40.3%) had normal and 224 (59.7%) had elevated preoperative hs-cTnI. Patients with normal preoperative hs-cTnI had a mean 6 h hs-cTnI of 9193 ng/l or 270X the upper normal value. Eleven patients (7.3%) presented with post-operative MI with a mean 6 h hs-cTnI of 50,218 ng/l or 1477X the upper normal value. Patients with elevated preoperative hs-cTnI had a mean 6 h hs-cTnI of 9449 ng/l or 292X the upper normal value. Eleven patients (4.9%) who presented with post-operative MI had a mean 6 h hs-cTnI of 26,823 ng/l or 789X the upper normal value. Conclusions We suggest hs-cTnI threshold of 80-fold in patients with normal pre-operative hs-cTnI and 2.7-fold in patients with elevated pre-operative hs-cTnI. These results have important implications for perioperative care and for surgical trial reporting.
Databáze: Directory of Open Access Journals
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