Usefulness of postoperative high-sensitive troponin T measurement and implications for defining type 5 infarction.

Details

Serval ID
serval:BIB_4D8844864947
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Usefulness of postoperative high-sensitive troponin T measurement and implications for defining type 5 infarction.
Journal
Journal of cardiac surgery
Author(s)
Niclauss L., Pfister R., Delay D., Tozzi P., Kirsch M., Prêtre R.
ISSN
1540-8191 (Electronic)
ISSN-L
0886-0440
Publication state
Published
Issued date
01/2022
Peer-reviewed
Oui
Volume
37
Number
1
Pages
151-161
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Guidelines indicate for type 5 myocardial infarction (MI) that postoperative troponin need not be exclusively ischemic but may also be caused by epicardial injury. Complexity arises from the introduction of high-sensitive troponin. This study attempts to contribute to the understanding of postoperative high-sensitive cardiac troponin T (hs-cTnT) increase.
The median enzyme increase of different cardiac operations was compared. Linear regression analyses were used to determine correlations between enzyme rise and independent parameters. Receiver-operating characteristics (ROC) served to evaluate the discriminatory power of enzyme rise in detecting ischemia and to determine possible thresholds.
Among 400 patients, 2.8% had intervention-related ischemia analogous to type 5 MI definition. The median postoperative hs-cTnT/creatine kinase myocardial band (CK-MB) increase varied according to types of surgery, with highest increase after mitral valve and lowest after off-pump coronary surgery. After ruling out patients with preoperatively elevated hs-cTnT, regression analysis confirmed Maze procedure (p < .001), intra-pericardial defibrillation (p = .002), emergency intervention (p = .01), blood transfusions (p = .02), and cardiopulmonary bypass time (p = .03) as significant factors associated with hs-cTnT increase. In addition, CK-MB increase was associated with mortality (p = .002). ROC confirmed good discriminatory power for hs-cTnT and CK-MB with ischemia-indicating thresholds of 1705.5 ng/L (hs-cTnT) and 113 U/L (CK-MB) considering different types of operations.
The Influence of the type of surgery and intervention-related parameters on hs-cTnT increase was confirmed. Potential thresholds indicating perioperative ischemia appear to be significantly elevated for high sensitive markers.
Keywords
Biomarkers, Creatine Kinase, Humans, Infarction, Postoperative Period, Troponin, Troponin T, cardiovascular pathology, cardiovascular research, coronary artery disease, valve repair/replacement
Pubmed
Web of science
Open Access
Yes
Create date
15/11/2021 13:42
Last modification date
21/12/2021 6:34
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