High sensitivity troponin-I threshold to predict perioperative myocardial infarction

• Published in: Journal of cardiothoracic surgery Vol. 18; no. 1; p. 234
• Main Authors: Friedman, Tom, Leviner, Dror B, Chan, Veronica, Yanagawa, Bobby, Orbach, Ady, Natour, Abd El Haleem, Weis, Anastasia, Sharoni, Erez, Bolotin, Gil
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17-07-2023; BioMed Central; BMC
• Subjects: Biomarkers; Bypass; Coronary artery; Coronary artery bypass; Coronary vessels; Electrocardiogram; Electrocardiography; Heart attack; Heart attacks; Heart surgery; Ischemia; Myocardial infarction; Patients; Sensitivity; Task forces; Troponin I
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-023-02323-0

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.
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.
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.
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.