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Value of Early Cardiac Troponin I to Predict Long-Term Adverse Events After Coronary Artery Bypass Graft After Coronary Artery Bypass Graft
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| 06.08.2009, 22:51 |
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Background: High values of both preoperative and postoperative cardiac troponin I (cTnI) contribute to higher
rates of short-term cardiac events following coronary artery bypass graft (CABG) surgery in patients with acute
coronary syndrome (ACS). The prognostic value of very early cTnI in this context is unclear.
Hypothesis: Measurement of cTnI very early after admission to the emergency room can be used as a
prognosticator for long-term outcomes after CABG.
Methods: We conducted a cohort study on 160 consecutive patients with ACS undergoing CABG at The John
H. Stroger Jr. Hospital of Cook County (Chicago, IL) representing a total follow-up of 290.42 person-years.
Adverse outcomes were defined as death or reinfarction. We used robust multivariate survival analyses to
determine whether early cTnI measurement can independently predict the adverse outcomes in the study
subjects.
Results: In univariate and stepwise multivariate Cox proportional hazards modeling we found that unit rise
in early cTnI is associated with a 3% (95% confidence interval [CI]: 2% −5%, p < 0.001) faster progression
to long-term adverse events after CABG even after adjusting for the type of ACS. Prognostically, the most
informative cut off value for cTnI was 5.6 ng/mL. Above this value, CABG patients progressed 2.58 times
faster to adverse outcomes (95% CI: 1.05–6.36, p = 0.039). This effect remained after adjustment for
other significant confounders namely, poor compliance to medications, female sex, Medicaid insurance, and
electrocardiographic ischemia.
Conclusion: Early cTnI measurement after admission can predict adverse outcomes after CABG. This association
extends to long-term adverse events after CABG.
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| Категория: Статьи | Добавил: nbylova
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