Cardiac troponin I level may predict complications after surgery
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Elevated serum cardiac troponin I level can potentially be used as a stand-alone marker to predict adverse outcomes after cardiac surgery, including mortality risk and postoperative MI, researchers reported.
“Cardiac surgeries are generally associated with high morbidity and mortality, and the ability to timely identify individuals at risk can help improve prognosis immensely,” Syed Ahmed, MBBS, from Dow University of Health Sciences, Karachi, Pakistan, told Healio. “Although several biomarkers have been evaluated to determine postoperative myocardial injury, they either lack sensitivity and specificity or are elevated for a short time. However, supplementing postoperative troponin I with preoperative risk scores such as the EuroSCORE and other markers, like creatinine kinase‐MB and cardiac troponin T, can lead to better detection of postoperative complications and hence a better prognosis.”
In a literature review, Ahmed and colleagues analyzed data from 13 studies (12 prospective) with 12,483 participants (77.8% men), conducted through May 2022 evaluating the role of cardiac troponin I in predicting postoperative mortality, MI and ICU and hospital stay among adults who underwent CABG and valvular replacement procedures. Cohort sizes ranged from 41 to 7,918 participants; mean age ranged from 54 to 73 years and 864 participants reported a previous MI.
The findings were published in the Journal of Cardiac Surgery.
Postoperative troponin I levels were mentioned in 11 of 13 studies and graphically represented in two studies; all were measured across a variety of time frames ranging from the end of cardiopulmonary bypass to 72 hours postoperatively. Mortality, ranging from in‐hospital to 5 years, was evaluated in eight of 13 studies. Four studies proposed cardiac troponin I as an independent predictor of mortality; the remaining studies reported troponin I was superior to the EuroSCORE and CK-MB as a predictor of event-free survival or the EuroSCORE was superior to troponin I.
Postoperative MI was assessed in six studies, with all reporting elevated troponin I levels among patients with postoperative MI. Three of the six studies suggested troponin I was an independent predictor; the remaining studies noted the marker was a more sensitive and specific marker than CK‐MB, a threshold to exclude postoperative MI or lacked any significant association.
Three studies evaluated ICU stay, with all reporting a significant association between elevated postoperative cardiac troponin I and a longer stay. Similarly, a longer length of hospital stay significantly correlated with elevated cardiac troponin I levels in all three studies evaluating it, the researchers wrote.
“While cardiac troponin I has massive potential to impact cardiac surgeries’ outcomes, there is a lack of standardization among conducted studies,” Ahmed told Healio. “Future studies must follow standardized protocols, including troponin level measurement at timed intervals employing homogenous assays. Lastly, a standardized cutoff value for elevated [cardiac troponin I] at selective intervals that offers the best prognostic value needs to be determined and comprehensive guidelines published to help raise adherence among surgeons.”
Reference:
Syed Ahmed, MBBS, can be reached at syedhassanahmed99@gmail.com; Twitter: @syedhassanhere.
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