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Usefulness of postoperative high-sensitive troponin T measurement and implications for defining type 5 infarction
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  • Lars Niclauss,
  • Raymond Pfister ,
  • Dominique Delay ,
  • Piergiorgio Tozzi,
  • Matthias Kirsch,
  • rené prêtre
Lars Niclauss
CHUV
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Raymond Pfister
CHUV
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Dominique Delay
Hopital du Valais
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Piergiorgio Tozzi
Centre Hospitalier Universitaire Vaudois
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Matthias Kirsch
Centre Hospitalier Universitaire Vaudois
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rené prêtre
CHUV
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Abstract

Background and aim of the study Guidelines on myocardial revascularization indicate for type V myocardial infarction (MI) that postoperative troponin elevations need not be exclusively ischemic but may also be caused by direct epicardial injury. Additional complexity arises from the introduction of high-sensitive troponin markers. The present study attempts to contribute to the understanding of postoperative high-sensitive cardiac troponin T (hs-cTnT) increase. Methods Type of surgery, potential factors affecting the postoperative hs-cTnT increase, and possible thresholds indicative of type V MI were analyzed. Results Among 400 included patients, 2.8% had intervention-related ischemia analogous to the type V MI definition. Receiver-operating characteristics confirmed good discriminatory power for hs-cTnT and creatine kinase myocardial band (CK-MB), with ischemia indicating thresholds for hs-cTnT (1705.5 ng/l) and for CK-MB (113 U/l). The median postoperative hs-cTnT/CK-MB increase differed significantly depending on the type of surgery, with the highest increase after mitral valve and the lowest after off-pump coronary surgery. Regression analysis confirmed Maze procedure (p<0.001), cardiopulmonary bypass time (p=0.03), emergency indications (p= 0.01) and blood transfusion (p=0.02) as significant factors associated with hs-cTnT increase. In contrast, CK-MB increase was also associated with mortality (p=0.002). Intra-pericardial defibrillation was the only ischemia-independent factor additionally associated with proposed thresholds (p<0.001). Conclusions The present results confirm the influence of the type of surgery and other intervention-related parameters on the postoperative hs-cTnT increase. Type V MI-indicating thresholds may require reassessment, especially using high-sensitive markers.

Peer review status:UNDER REVIEW

31 May 2021Submitted to Journal of Cardiac Surgery
31 May 2021Assigned to Editor
31 May 2021Submission Checks Completed
04 Jun 2021Reviewer(s) Assigned