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Eur J Cardiothorac Surg 2005;27:861-869
© 2005 Elsevier Science NL

Risk stratification with cardiac troponin I in patients undergoing elective coronary artery bypass surgery

^a Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Clinic of Essen, Hufelandstraße 55, 45122 Essen, Germany
^b Institute for Medical Informatics, Biometry, and Epidemiology, University Clinic of Essen, Essen, Germany

Received 14 October 2004; received in revised form 19 January 2005; accepted 21 January 2005.

^* Corresponding author. Tel.: +49 201 723 4928; fax: +49 201 723 5451. (E-mail: matthias.thielmann{at}uni-essen.de).

Objective: Cardiac troponin I (cTnI) is a highly sensitive and specific marker for postoperative prediction of patients outcome after coronary artery bypass surgery (CABG). Whether preoperatively elevated cTnI levels similarly predict the outcome in patients scheduled for elective CABG is currently unknown. Methods: Therefore, a possible correlation between preoperative cTnI levels and perioperative major adverse events and in-hospital mortality after CABG was investigated. CTnI was measured within 24h before surgery in 1405 out of 3124 consecutive elective CABG patients. Out of these patients, 1178 had a preoperative cTnI level below 0.1ng/ml (group 1), 163 patients had a cTnI level between 0.11 and 1.5ng/ml (group 2), and 64 patients had a cTnI level above 1.5ng/ml (group 3). CTnI levels, electrocardiograms, clinical data, adverse events and in-hospital mortality were recorded prospectively. Patients with ST-elevation myocardial infarction less than 7 days before surgery were excluded from the study. Results: Perioperative myocardial infarction (PMI) occurred in 69/1178 patients (5.9%) in group 1, 14/163 patients (8.6%; odds ratio (OR) 1.5, 95% confidence interval (CI): 0.8–2.8) in group 2, and 11/64 patients (17.2%; OR 3.3, CI: 1.6–7.0) in group 3 (overall: P<0.001, Cochran-Armitage trend test). Low cardiac output syndrome (LCOS) occurred in 19/1178 patients (1.6%), 9/163 (5.5%; OR 3.6, CI: 1.5–8.5), and 7/64 patients (10.9%; OR 7.5, CI: 2.7–19.8) (overall: P<0.001, group 1 vs. group 2: P<0.002), respectively. In-hospital mortality was 1.7% in group 1 and 3.1% in group 2, but 6.3% (OR 3.9, CI: 1.1–12.5) in group 3 (overall: P<0.01, group 1 vs. group 2: P=NS). Intensive care and hospital stay were significantly longer in group 3 compared to groups 1 and 2. Univariate and multivariate logistic regression analysis confirmed the statistically significant relationship between cTnI and PMI, LCOS and in-hospital mortality, respectively (P<0.001). Conclusions: Risk stratification by measurement of cTnI levels within 24h before elective CABG clearly identifies a subgroup of patients with increased risk for postoperative adverse outcome and in-hospital mortality.

Key Words: Coronary artery bypass grafting • Risk stratification • Patients outcome • Cardiac troponin I

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