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Kinetic analysis of cardiac troponin I release is no more accurate than a single 24-h measurement in predicting in-hospital outcome after cardiac surgery

Published online by Cambridge University Press:  01 June 2008

J.-L. Fellahi ,
J.-L. Hanouz ,
X. Gué ,
E. Monier ,
L. Guillou  and
B. Riou
J.-L. Fellahi*
Affiliation:
Centre Hospitalier Privé Saint-Martin, Departments of Anesthesiology, Biology, Cardiothoracic Surgery, Caen, Paris, France
J.-L. Hanouz
Affiliation:
Centre Hospitalier Régional Universitaire, Department of Anesthesiology, Critical Care and Prehospital Medicine, Caen, Paris, France
X. Gué
Affiliation:
Centre Hospitalier Privé Saint-Martin, Departments of Anesthesiology, Biology, Cardiothoracic Surgery, Caen, Paris, France
E. Monier
Affiliation:
Centre Hospitalier Privé Saint-Martin, Departments of Anesthesiology, Biology, Cardiothoracic Surgery, Caen, Paris, France
L. Guillou
Affiliation:
Centre Hospitalier Privé Saint-Martin, Departments of Anesthesiology, Biology, Cardiothoracic Surgery, Caen, Paris, France
B. Riou
Affiliation:
CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Department of Emergency Medicine, Paris, France
*
Service d’Anesthésie Réanimation, CHP Saint-Martin, 18 rue des Roquemonts, 14050 Caen Cedex 4, France. E-mail: jean-luc.fellahi@gdsnb.gsante.fr; Tel: +33 231 433 120; Fax: +33 231 433 124.
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Summary

Background and objective

A single cardiac troponin I (cTnI) 24-h measurement is an independent predictor of short- and long-term adverse outcome after coronary surgery. We compared a single cTnI 24-h measurement and kinetic analysis of cTnI release in predicting in-hospital outcome in unselected cardiac surgery patients.

Methods

Consecutive patients (n = 184) undergoing cardiac surgery with cardiopulmonary bypass were included and divided into two groups according to the time course of postoperative peak serum cTnI (6 or 24 h after surgery). Serial measurements of cTnI were performed the day before surgery, at the end of surgery and 6, 24 and 120 h after surgery in all patients. The total amount of cTnI released (integrated area under the curve), postoperative major adverse cardiac events (ventricular arrhythmias, myocardial infarction and congestive heart failure) and in-hospital death were recorded. Data are expressed as median (95% CI).

Results

In all, 152 (83%) patients had an early peak cTnI (6 h after surgery) and 32 (17%) patients had a late peak cTnI (24 h after surgery). The integrated area under the curve differed between both groups: 159 (142–178) vs. 321 (255–590), respectively, P < 0.001. Major adverse cardiac events and/or death (22 vs. 9%, P = 0.04) was greater in patients with a late peak cTnI. The integrated area under the curve and the peak value of cTnI were no more accurate than a single 24-h measurement in predicting the occurrence of major adverse cardiac events and/or death.

Conclusions

Kinetic analysis of cTnI release was no more accurate than a single 24-h measurement in predicting in-hospital poor outcome.

Keywords

TROPONIN ICARDIAC SURGERYPOSTOPERATIVE PERIODOUTCOME ASSESSMENT
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 6 , June 2008 , pp. 490 - 497
Copyright
Copyright © European Society of Anaesthesiology 2008

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