High sensitivity troponin-I threshold to predict perioperative myocardial infarction
Abstract Background High-sensitivity Troponin I (hs-cTnI) has largely replaced conventional troponin assays in an effort to improve detection of myocardial infarction. However, the mean displacement of hs-cTnI following coronary artery bypass graft (CABG) and the optimal threshold to detect perioper...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-07-01
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| Series: | Journal of Cardiothoracic Surgery |
| Online Access: | https://doi.org/10.1186/s13019-023-02323-0 |
| _version_ | 1797773986890776576 |
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| author | Tom Friedman Dror B. Leviner Veronica Chan Bobby Yanagawa Ady Orbach Abd El Haleem Natour Anastasia Weis Erez Sharoni Gil Bolotin |
| author_facet | Tom Friedman Dror B. Leviner Veronica Chan Bobby Yanagawa Ady Orbach Abd El Haleem Natour Anastasia Weis Erez Sharoni Gil Bolotin |
| author_sort | Tom Friedman |
| collection | DOAJ |
| description | Abstract Background High-sensitivity Troponin I (hs-cTnI) has largely replaced conventional troponin assays in an effort to improve detection of myocardial infarction. However, the mean displacement of hs-cTnI following coronary artery bypass graft (CABG) and the optimal threshold to detect perioperative myocardial infarction (MI) is unclear. Our objective is to describe mean hs-cTnI values at 6–12 h post-CABG and to determine the highest specificity while maintaining 100% sensitivity hs-cTnI cut-off values for diagnosis of perioperative or type-5 MI. Methods Between 2016 and 2018, 374 patients underwent non-emergent, isolated CABG. Pre-operative and 6 h post-operative hs-cTnI values were recorded as well as ECG, echocardiographic and angiographic data. Results Of 374 patients, 151 (40.3%) had normal and 224 (59.7%) had elevated preoperative hs-cTnI. Patients with normal preoperative hs-cTnI had a mean 6 h hs-cTnI of 9193 ng/l or 270X the upper normal value. Eleven patients (7.3%) presented with post-operative MI with a mean 6 h hs-cTnI of 50,218 ng/l or 1477X the upper normal value. Patients with elevated preoperative hs-cTnI had a mean 6 h hs-cTnI of 9449 ng/l or 292X the upper normal value. Eleven patients (4.9%) who presented with post-operative MI had a mean 6 h hs-cTnI of 26,823 ng/l or 789X the upper normal value. Conclusions We suggest hs-cTnI threshold of 80-fold in patients with normal pre-operative hs-cTnI and 2.7-fold in patients with elevated pre-operative hs-cTnI. These results have important implications for perioperative care and for surgical trial reporting. |
| first_indexed | 2024-03-12T22:13:59Z |
| format | Article |
| id | doaj.art-e78f377143a24e2c97dcf7f80c787591 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-03-12T22:13:59Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-e78f377143a24e2c97dcf7f80c7875912023-07-23T11:26:21ZengBMCJournal of Cardiothoracic Surgery1749-80902023-07-011811810.1186/s13019-023-02323-0High sensitivity troponin-I threshold to predict perioperative myocardial infarctionTom Friedman0Dror B. Leviner1Veronica Chan2Bobby Yanagawa3Ady Orbach4Abd El Haleem Natour5Anastasia Weis6Erez Sharoni7Gil Bolotin8Department of Cardiac Surgery, Rambam Health Care CampusDepartment of Cardiothoracic Surgery, Carmel Medical CenterDivision of Cardiac Surgery, St Michael’s Hospital, University of TorontoDivision of Cardiac Surgery, St Michael’s Hospital, University of TorontoDepartment of Cardiology, Rambam Health Care CampusDepartment of Cardiac Surgery, Rambam Health Care CampusDepartment of Cardiac Surgery, Rambam Health Care CampusDepartment of Cardiothoracic Surgery, Carmel Medical CenterDepartment of Cardiac Surgery, Rambam Health Care CampusAbstract Background High-sensitivity Troponin I (hs-cTnI) has largely replaced conventional troponin assays in an effort to improve detection of myocardial infarction. However, the mean displacement of hs-cTnI following coronary artery bypass graft (CABG) and the optimal threshold to detect perioperative myocardial infarction (MI) is unclear. Our objective is to describe mean hs-cTnI values at 6–12 h post-CABG and to determine the highest specificity while maintaining 100% sensitivity hs-cTnI cut-off values for diagnosis of perioperative or type-5 MI. Methods Between 2016 and 2018, 374 patients underwent non-emergent, isolated CABG. Pre-operative and 6 h post-operative hs-cTnI values were recorded as well as ECG, echocardiographic and angiographic data. Results Of 374 patients, 151 (40.3%) had normal and 224 (59.7%) had elevated preoperative hs-cTnI. Patients with normal preoperative hs-cTnI had a mean 6 h hs-cTnI of 9193 ng/l or 270X the upper normal value. Eleven patients (7.3%) presented with post-operative MI with a mean 6 h hs-cTnI of 50,218 ng/l or 1477X the upper normal value. Patients with elevated preoperative hs-cTnI had a mean 6 h hs-cTnI of 9449 ng/l or 292X the upper normal value. Eleven patients (4.9%) who presented with post-operative MI had a mean 6 h hs-cTnI of 26,823 ng/l or 789X the upper normal value. Conclusions We suggest hs-cTnI threshold of 80-fold in patients with normal pre-operative hs-cTnI and 2.7-fold in patients with elevated pre-operative hs-cTnI. These results have important implications for perioperative care and for surgical trial reporting.https://doi.org/10.1186/s13019-023-02323-0 |
| spellingShingle | Tom Friedman Dror B. Leviner Veronica Chan Bobby Yanagawa Ady Orbach Abd El Haleem Natour Anastasia Weis Erez Sharoni Gil Bolotin High sensitivity troponin-I threshold to predict perioperative myocardial infarction Journal of Cardiothoracic Surgery |
| title | High sensitivity troponin-I threshold to predict perioperative myocardial infarction |
| title_full | High sensitivity troponin-I threshold to predict perioperative myocardial infarction |
| title_fullStr | High sensitivity troponin-I threshold to predict perioperative myocardial infarction |
| title_full_unstemmed | High sensitivity troponin-I threshold to predict perioperative myocardial infarction |
| title_short | High sensitivity troponin-I threshold to predict perioperative myocardial infarction |
| title_sort | high sensitivity troponin i threshold to predict perioperative myocardial infarction |
| url | https://doi.org/10.1186/s13019-023-02323-0 |
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