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Preoperative troponin levels and outcomes of coronary surgery following myocardial infarction
Author(s) -
Hess Nicholas R.,
Sultan Ibrahim,
Wang Yisi,
Thoma Floyd W.,
Kilic Arman
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15557
Subject(s) - medicine , myocardial infarction , cardiology , troponin , troponin i
Background This study evaluates the impact of peak preoperative troponin level on outcomes of coronary artery bypass grafting (CABG) for non‐ST‐elevation myocardial infarction (NSTEMI). Methods This was a retrospective review of patients undergoing isolated CABG from 2011 to 2018 with the presentation of NSTEMI. Patients were stratified into low‐ and high‐risk groups based on median preoperative peak troponin (1.95 ng/dl). Major adverse cardiac and cerebrovascular events (MACCE) and mortality were compared. Multivariable analysis was performed to model risk factors for MACCE and mortality. Results This study included 1211 patients, 607 low‐risk (≤1.95 ng/dl) and 604 high‐risk (>1.95 ng/dl). Patients were well‐matched with respect to age and comorbidity. High‐risk patients had lower median preoperative ejection fraction (46.5% [interquartile range {IQR}: 35.0%–55.0%] vs. 53.0% [IQR: 40.0%–58.0%]) and higher incidence of preoperative intra‐aortic balloon pump (15.9% vs. 8.73%). Intensive care unit and hospital length of stay were longer in the high‐risk group, but increasing troponin level was not associated with prolonged intensive care or hospital length of stay (>4 and >14 days, respectively) after risk adjustment. Postoperative complications and 30‐day, 1‐ and 5‐year rates of both MACCE and survival were similar between groups. Peak troponin greater than 1.95 ng/dl was not associated with increased hazards for MACCE, mortality, or readmission in multivariable modeling. In subanalysis, neither increasing troponin as a continuous variable nor peak troponin greater than 10.00 ng/ml were associated with increased hazards for these outcomes. Conclusions Preoperative troponin levels do not appear to be predictive of short‐ or long‐term outcomes following CABG, and clinical decisions regarding surgical revascularization should not be dictated by these measurements.