title: Troponin I levels and postoperative myocardial infarction following renal transplantation.
abstract: BACKGROUND
  The relationship of routine postoperative troponin I (TnI) monitoring in kidney transplant recipients and in-hospital myocardial infarction (MI) is not known.
  
  
  METHODS
  This observational study evaluated the prevalence of abnormal postoperative TnI (Ortho Clinical Diagnostics assay) in 376 consecutive kidney or kidney/pancreas transplant recipients. In-hospital MI was adjudicated using the universal definition. Rates of death and coronary revascularizations at 1 year were studied. Logistic regression analysis was performed to identify independent predictors of abnormal TnI.
  
  
  RESULTS
  Ninety-five (25%) recipients had abnormal TnI (>0.04 ng/ml) following transplantation. Abnormal TnI levels were more common in older (mean age: 52.2 ± 13.4 vs. 48.3 ± 13.2 years, p = 0.01), diabetic (57.9 vs. 45.6%, p = 0.04), and prior coronary artery disease (31.6 vs. 20.3%, p = 0.02) patients. In-hospital MI occurred in 6 patients (1.6%). All subsequent in-hospital cardiovascular events occurred in the abnormal postoperative TnI group; most in those with TnI levels >1 ng/ml. Previous coronary artery disease was the only independent predictor of a postoperative TnI level >1 ng/ml in multivariate analysis (odds ratio 4.61, 95% confidence interval 1.49-14.32). At 1 year there was no significant difference in death (3.2 vs. 1.8%, p = 0.42) and borderline significant difference in coronary revascularization (5.3 vs. 1.4%, p = 0.049) in abnormal versus normal TnI groups.
  
  
  CONCLUSIONS
  In-hospital MI was infrequent, but abnormal TnI highly prevalent following renal transplantation. Normal TnI levels following renal transplantation had a high negative predictive value in excluding patients likely to develop subsequent postoperative MI. The role of a higher TnI cut-off for screening for postoperative MI in high-risk subgroups deserves future prospective evaluation.
authors.affiliation: Division of Cardiology, Hennepin County Medical Center, Minneapolis, MN 55155, USA. shrof010@umn.edu
authors.forename: G R
authors.initials: GR
authors.lastname: Shroff
authors.forename: S K
authors.initials: SK
authors.lastname: Akkina
authors.forename: M D
authors.initials: MD
authors.lastname: Miedema
authors.forename: R
authors.initials: R
authors.lastname: Madlon-Kay
authors.forename: C A
authors.initials: CA
authors.lastname: Herzog
authors.forename: B L
authors.initials: BL
authors.lastname: Kasiske
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D009204:Myocardial Revascularization; D011184:Postoperative Period; D015995:Prevalence; D012189:Retrospective Studies; D019210:Troponin I / Q000097:blood*
chemical_list: D019210:Troponin I