This retrospective, observational study included 8292 consecutive patients (median age, 68 years; 31% women), 24% with a history of myocardial infarction) and 14% with a prior percutaneous coronary intervention (PCI), who underwent cardiac surgery. For all patients, high-sensitivity cardiac troponin T (hs-cTnT) values were available.
Researchers used postoperative troponin release levels to assess the association of perioperative myocardial injury with 30-day mortality and long-term survival for three surgery categories ― coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), and all other cardiac surgeries.
Death within 30 days occurred in 2.5% of the patients (1.7% for CABG, 1.7% for AVR, and 3.1% for other cardiac procedures).
High levels of hs-cTnT were associated with 30-day mortality; the risk of death increased with every unit of log peak hs-cTnT value after CABG (hazard ratio [HR], 4.79; 95% CI 2.898 – 10.21), after AVR (HR, 2.33; 95% CI, 0.95 – 13.82), and after other cardiac surgeries (HR, 1.99; 95% CI, 1.56 – 2.65).
The threshold hs-cTnT level for predicting 30-day mortality was 2385 ng/L (170 times the upper limit of normal in a seemingly healthy population [URL]) for isolated CABG, 568 ng/L (41 URL) for isolated AVR, and 1873 ng/L (134 URL) for other cardiac surgeries, which are markedly higher cutoffs than suggested in current definitions.
These results provide important novel insights into the association of hs-cTnT with 30-day mortality and indicate that the thresholds used in current definitions of peri-procedural myocardial injury are too conservative in predicting mortality,
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