title: Predicting adverse outcomes in elective coronary artery bypass graft surgery using pre-operative troponin I levels.
abstract: BACKGROUND
  Cardiac troponins are frequently measured as part of the pre-operative work-up of patients prior to coronary artery bypass graft surgery (CABG). The utility of measuring these levels in elective patients, and the clinical implication of an abnormal result are unclear. The following study investigates the relationship between cardiac troponin I (cTnI) measured as part of a routine pre-operative work-up and outcomes following CABG.
  
  
  METHODS
  From January 2010 to December 2012, 378 patients underwent isolated, elective CABG and had cTnI measured prospectively, as part of their pre-operative work-up. Patients were divided into normal (Group I) and elevated (Group II) cTnI groups. Pre-operative, operative and post-operative data were obtained from our institution's prospectively collected database.
  
  
  RESULTS
  Elevated cTnI was present in 47 patients (12.4%) pre-operatively. Intra-operative variables did not differ between the elevated cTnI and control groups. Both 30-day mortality (Group I: 0.9% v Group II: 6.4%, p=0.03) and cardiac arrest (Group I: 1.5% v Group II: 8.5%, p=0.01) were significantly more frequent in the elevated cTnI group. In multivariable analysis, elevated cTnI remained a predictor for cardiac arrest (OR 5.8, 95% CI 1.2 - 29.2).
  
  
  CONCLUSIONS
  Patients presenting for elective CABG frequently have elevated cTnI on pre-operative work-up. These patients may be at a greater risk of 30-day mortality and cardiac arrest. Routine pre-operative measurement of cTnI may alert clinicians to a higher operative risk.
authors.affiliation: Department of Cardiothoracic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia; Department of Surgery, St Vincent's Hospital, The University of Melbourne, Australia. Electronic address: edward.buratto@svhm.org.au.
authors.forename: Edward
authors.initials: E
authors.lastname: Buratto
authors.affiliation: Department of Cardiothoracic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia; Department of Surgery, St Vincent's Hospital, The University of Melbourne, Australia; Cardiovascular Research Centre, Australian Catholic University, East Melbourne, Victoria, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Conaglen
authors.affiliation: Department of Cardiothoracic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia.
authors.forename: Jim
authors.initials: J
authors.lastname: Dimitriou
authors.affiliation: Department of Cardiothoracic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia; Department of Surgery, St Vincent's Hospital, The University of Melbourne, Australia.
authors.forename: Leonard
authors.initials: L
authors.lastname: Shan
authors.affiliation: Department of Cardiothoracic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia; Department of Surgery, St Vincent's Hospital, The University of Melbourne, Australia.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Yii
authors.affiliation: Department of Cardiothoracic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia; Department of Surgery, St Vincent's Hospital, The University of Melbourne, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosalion
authors.affiliation: Department of Cardiothoracic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia; Department of Surgery, St Vincent's Hospital, The University of Melbourne, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Davis
authors.affiliation: Department of Cardiothoracic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia; Department of Surgery, St Vincent's Hospital, The University of Melbourne, Australia; Cardiovascular Research Centre, Australian Catholic University, East Melbourne, Victoria, Australia.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Newcomb
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D016208:Databases, Factual; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000401:mortality / Q000601:surgery; D011300:Preoperative Care; D015996:Survival Rate; D013997:Time Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D019210:Troponin I
keywords: CABG; Myocardial ischaemia; Outcomes; Pre-operative care; Troponin