title: Early troponin T and prediction of potentially correctable in-hospital complications after coronary artery bypass grafting surgery.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiovascular Surgery, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland.
authors.forename: Volkhard
authors.initials: V
authors.lastname: Göber
authors.forename: Andreas
authors.initials: A
authors.lastname: Hohl
authors.forename: Brigitta
authors.initials: B
authors.lastname: Gahl
authors.forename: Florian
authors.initials: F
authors.lastname: Dick
authors.forename: Verena
authors.initials: V
authors.lastname: Eigenmann
authors.forename: Thierry P
authors.initials: TP
authors.lastname: Carrel
authors.forename: Hendrik T
authors.initials: HT
authors.lastname: Tevaearai
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000473:pathology / Q000601:surgery; D042241:Early Diagnosis; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D051437:Renal Insufficiency / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D012306:Risk; D012680:Sensitivity and Specificity; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D020107:Troponin T / Q000097:blood*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D020107:Troponin T; D014662:Vasoconstrictor Agents
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