title: Cardiac troponin release following hybrid coronary revascularization versus off-pump coronary artery bypass surgery.
abstract: OBJECTIVE
  Cardiac ischaemic marker release is associated with adverse clinical outcomes after cardiac surgery. We sought to compare the release of cardiac troponin I (cTnI) after hybrid coronary revascularization (HCR) with off-pump coronary artery bypass surgery (OPCAB).
  
  
  METHODS
  Using data from a prospective single-centre registry, we compared cTnI measured at postoperative day 1 following one-stage HCR and OPCAB among patients with normal baseline cTnI. Multivariable linear regression analysis was used to adjust for variables that may have influenced cardiac marker release other than the used revascularization strategy.
  
  
  RESULTS
  Sixty-five consecutive patients underwent elective HCR (n = 33) or OPCAB (n = 32). Overall, no differences were seen in comorbidities, CABG risk scores and the lesion-specific SYNTAX score. Procedural complications were lower (15.2 vs 34.4%, P = 0.072), but 30-day and 1-year clinical outcomes (death, myocardial infarction, and repeat revascularization) were similar between the two groups (3.0 vs 3.1% and 9.1 vs 6.2%, respectively). Post-procedural cTnI release measured at 24 h after surgery was significantly lower following HCR compared with OPCAB [ratio of upper reference level URL: median: 3.5, interquartile range (IQR): 0.8-9.1 vs 12.8, IQR: 6.9-21.8, P = 0.001]. After adjusting for potential confounders, HCR was associated, on average, with cTnI less than half (46%) compared with CABG (P <0.0001).
  
  
  CONCLUSIONS
  HCR is associated with lower postoperative cTn release, compared with OPCAB. Further research into the clinical implications of this finding is warranted.
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands r.e.harskamp@gmail.com.
authors.forename: Ralf E
authors.initials: RE
authors.lastname: Harskamp
authors.affiliation: Pinnacle Health Cardiovascular Institute, Harrisburg, PA, USA.
authors.forename: Murad
authors.initials: M
authors.lastname: Abdelsalam
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.affiliation: Pinnacle Health Cardiovascular Institute, Harrisburg, PA, USA.
authors.forename: Gouthami
authors.initials: G
authors.lastname: Boga
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Hirji
authors.affiliation: Pinnacle Health Cardiovascular Institute, Harrisburg, PA, USA.
authors.forename: Mrinalini
authors.initials: M
authors.lastname: Krishnan
authors.affiliation: Pinnacle Health Cardiovascular Institute, Harrisburg, PA, USA.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Kiljanek
authors.affiliation: Pinnacle Health Cardiovascular Institute, Harrisburg, PA, USA.
authors.forename: Mubashir
authors.initials: M
authors.lastname: Mumtaz
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Jan G
authors.initials: JG
authors.lastname: Tijssen
authors.affiliation: Pinnacle Health Cardiovascular Institute, Harrisburg, PA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: McCarty
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.affiliation: Pinnacle Health Cardiovascular Institute, Harrisburg, PA, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: Bachinsky
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Cardiac troponin; Coronary artery bypass surgery; Hybrid coronary revascularization