Publication

Association of Troponin Trends and Cardiac Morbidity and Mortality After On-Pump Cardiac Surgery

Journal Paper/Review - Oct 1, 2017

Units
PubMed
Doi

Citation
Mauermann E, Bolliger D, Fassl J, Grapow M, Seeberger E, Seeberger M, Filipovic M, Lurati Buse G. Association of Troponin Trends and Cardiac Morbidity and Mortality After On-Pump Cardiac Surgery. Ann Thorac Surg 2017; 104:1289-1297.
Type
Journal Paper/Review (English)
Journal
Ann Thorac Surg 2017; 104
Publication Date
Oct 1, 2017
Issn Electronic
1552-6259
Pages
1289-1297
Brief description/objective

BACKGROUND
Elevated, single-measure, postoperative troponin is associated with adverse events after cardiac surgery. We hypothesized that increases in troponin from the first to the second postoperative day are also associated with all-cause, 12-month mortality and major adverse cardiac events (MACE).

METHODS
This observational study included consecutive adults undergoing on-pump cardiac surgery with cardiac arrest. Troponin T was measured on the first and second postoperative day and was classified as "increasing" (>10%), "unchanged" (10% to -10%), or "decreasing" (<-10%). The primary endpoint was all-cause, 12-month mortality. Secondary endpoints were all-cause 12-month mortality or MACE and both outcomes at 30 days. The main analysis was by multivariable Cox regression.

RESULTS
Of 1,417 included patients, 99 (7.0%) died and 162 (11.4%) died or suffered MACE at 12 months. A significant interaction (p < 0.001) between first postoperative day troponin and the troponin trend from the first to the second postoperative day on 12-month, all-cause mortality precluded an analysis independent of first postoperative day troponin. Consequently, we stratified patients by their first postoperative day troponin (cutoff, 0.8 μg/L). Increasing troponin was associated with higher mortality in patients with first postoperative day troponin T ≥ 0.8 μg/L (hazard ratio, 1.98; 95% CI, 1.09 to 3.59; p = 0.025).

CONCLUSIONS
Troponin changes from the first to the second postoperative day should not be interpreted without consideration of the first postoperative day troponin concentration. For patients with a first postoperative day troponin ≥ 0.8 μg/L, an increase by more than 10% from the first to the second postoperative day was significantly associated with all-cause, 12-month mortality and other adverse events.