Troponin I levels before bypass surgery after acute myocardial infarction; When to operate?
Keywords:Acute myocardial infarction, Coronary artery bypass surgery, Troponin I
Aim: Measurement of cardiac troponin I (cTnI) preop coronary artery bypass surgery (CABG) may be a determinant of surgical risk in patients with myocardial infarction (MI). Our aim is to explain the prognostic value of the preoperative serum levels of cardiac troponin I in patients with a recent acute MI under relatively stable clinical conditions.
Methods: This study was a retrospective single-center study in a small state hospital in Turkey. Included were 65 patients that had undergone a first-time isolated CABG between January 2012 and December 2014 due to acute MI. Samples for preoperative cTnI measurements were collected daily prior to the operation. Patients were enrolled in this study if they had nonST or ST elevation MI and had also undergone an early isolated CABG. We evaluated the association between serum levels of cTnI 24 hours before CABG and postoperative in-hospital patient outcomes.
Results: In cases with mortality troponin was high but it was not statistically significant. There was a significant poor positive correlation between admission troponin and intensive care unit (ICU) stay and the duration of discharge. No statically significant correlation was found between troponin levels and other postoperative in- hospital patient outcomes.
Conclusion: Although there was no significant correlation between troponin values and postoperative data troponin was higher than those without mortality. Therefore we suggest that if the vital signs are stable for patients with AMI preparing to undergo CABG, surgery should be delayed until troponin falls to nearly normal values.
Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined -a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol. 2000;36:959-69.
The Joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined—a consensus document of the Joint European Society of Cardiology/ American College of Cardiology Committee for the redefinition ofmyocardial infarction. Eur Heart J 2000;21:1502–13.
Adam JE, Bodor GS, Davila-Roman VG, Delmez JA, Apple FS, Ladenson JH, et al. Cardiac troponin I: a marker with big specificity for cardiac injury. Circulation. 1993;88:101-6.
Nesher N, Alghamdi AA, Singh SK, Sever JY, Christakis GT, Goldman BS, et al. Troponin after cardiac surgery: apredictor or a phenomenon? Ann Thorac Surg. 2008;85:1348–54.
Wu AH, Apple FS, Gibler WB, Jesse RL, Warshaw MM, Valdes R Jr. National Academy of Clinical Biochemistry Standards of Laboratory Practice: recommendations for the use of cardiac markers in coronary artery diseases. Clin Chem. 1999;45:1104 –21.
Caputo M, Dihmis W, Birdi I, Reeves B, Suleiman MS, Angelini GD, et al. Cardiac Troponin T and Troponin I release duringcoronary artery surgery using cold crystalloid and cold blood cardio-plegia. Eur J Cardio-thorac Surg. 1997;12:254-60.
Tu JV, Jaglal SB, Naylor CD. Multicenter validation of a riskindex for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. Circulation. 1995;91:677-84.
Paparella D, Scrascia G, Paramythiotis A, Guida P, Magari V, Malvindi PG, et al. Preoperative Cardiac Troponin I to Assess Midterm Risks of Coronary Bypass Grafting Operations in Patients With Recent Myocardial Infarction. Ann Thorac Surg. 2010;89:696–703.
Giannitsis E, Muller-Bardorff M, Lehrke S, Wiegand U, Tölg R, Weidtmann B, et al. Admission troponin T level predicts clinical outcomes, TIMI flow, and myocardial tissue perfusion after primary percutaneous intervention for acute ST-segment elevation myocardial infarction. Circulation. 2001; 104:630–35.
Landesberg G, Shatz V, Akopnik I, Wolf YG, Mayer M, Berlatzky Y, et al. Association of cardiac troponin, CK-MB and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol. 2003;42:1547–54.
Lehrke S, Steen H, Sievers HH, Peters H, Opitz A, Müller-Bardorff M, et al. Cardiac troponin T for prediction of short- and long-term morbidity and mortality after elective openheart surgery. Clin Chem. 2004;50:1560–7.
Thielmann M, Massoudy P, Marggraf G, Knipp S, Schmermund A, Piotrowski J, et al.Role of troponin I, myoglobin, and creatine kinase for the detection of early graft failure following coronary artery bypass grafting. Eur J Cardio-Thorac Surg. 2004;26:102–9.
Nagele P, Brown F, Gage BF, Gibson DW, Miller JP, Jaffe AS, et al. High-sensitivity cardiac troponin T in prediction and diagnosis of myocardial infarction and long-term mortality after noncardiac surgery. Am Heart J. 2013;166(2):325-32.
Carrier M, Pelletier LC, Martineau R, Pellerin M, Solymoss BC. In elective coronary artery bypass grafting, preoperative troponin T level predicts the risk of myocardial infarction. J Thorac Cardiovasc Surg. 1998;115:1328–34.
Thielmann M, Massoudy P ,NeuhauserM, Knipp S, Kamler M, Piotrowski J, et al. Prognostic Value of Preoperative Cardiac Troponin I in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Artery Bypass Surgery. Chest. 2005; 128:3526-36.
Montgomery VL, Sullivan JE, Buchino JJ. Prognostic value of pre-and postoperative cardiac troponin I measurement in childrenhaving cardiac surgery. Pediatr Dev Pathol. 2000;3:53– 60.
Kim LJ, Martinez EA, Faraday N, Dorman T, Fleisher LA, Perler BA, et al. Cardiac Troponin I Predicts Short-Term Mortality in Vascular Surgery Patients. Circulation. 2002; 106(18):2366-71.
Onorati F, De Feo M, Mastroroberto P, Cristodoro L, Pezzo F, Renzulli A, et al. Determinants and prognosis of myocardial damage after coronary artery bypass grafting. Ann Thorac Surg. 2005;79:837–45.
Adabag AS, Rector T, Mithani S, Harmala J, Ward HB, Kelly RF, et al. Prognostic significance of elevated cardiac troponin I after heart surgery. Ann Thorac Surg. 2007;83:1744–50.
Weiss ES, Chang DD, Joyce DL, Nwakanma LU, Yuh DD.. Optimal timing of coronary artery bypass after acute myocardial infarction: a review of California discharge data. J Thorac Cardiovasc Surg. 2008;135:503–11.
Lee DC, Oz MC, Weinberg AD, Lin SX, Ting W. Optimal timing of revascularization: transmural versus nontransmural acute myocardial infarction. Ann Thorac Surg. 2001;71:198–204.
Braxton JH, Hammond GL, Letsou GV, Braxton JH, Hammond GL, Letsou GV, et al. Optimal timing of coronary artery bypass graft surgery after acutemyocardial infarction. Circulation. 1995;92:66–8.
Parikh SV, de Lemos JA, Jessen ME, Brilakis ES, Ohman EM, Chen AY, et al. Timing of in-hospitalcoronary artery bypass graft surgery for non- ST segment elevation myocardial infarction patients: Results From theNational Cardiovascular Data Registry ACTION Registry–GWTG (Acute CoronaryTreatment and Intervention Outcomes Network Registry–Get With The Guidelines). JACC Cardiovasc Interv. 2010;3:419–27.
Paparella D, Scrascia G, Paramythiotis A, Guida P, Magari V, Malvindi PG, et al. Preoperative cardiac troponin I to assess midterm risks of coronary bypass grafting operations in patients with recent myocardial infarction. Ann Thorac Surg. 2010;89:696–702.
- 1286 2088
How to Cite
Copyright (c) 2018 Mihriban Yalçın, Eda Gödekmerdan Katırcıoğlu, Serkan Yazman, Kaptanı Derya Tayfur, Melih Ürkmez
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.