scholarly journals Combination of EuroSCORE and Cardiac Troponin I Improves the Prediction of Adverse Outcome after Cardiac Surgery

2011 ◽  
Vol 114 (2) ◽  
pp. 330-339 ◽  
Author(s):  
Jean-Luc Fellahi ◽  
Yannick Le Manach ◽  
Georges Daccache ◽  
Bruno Riou ◽  
Jean-Louis Gérard ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Hospital Mortality ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Adverse Outcome ◽  
Major Adverse Cardiac Events ◽  
Discriminative Power ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Integrated Discrimination Improvement

Background Reclassification tables have never been used to compare concentrations of cardiac troponin I (cTnI) with predictive models of risk in the perioperative setting. The current study aimed to evaluate the prognostic value of pre- and/or postoperative serum cTnI when combined with The European System for Cardiac Operative Risk Evaluation (EuroSCORE) in predicting adverse outcome after cardiac surgery. Methods Nine hundred five consecutive patients were included. Standard EuroSCORE as well as preoperative and 24-h postoperative cTnI were measured in all patients. Major adverse cardiac events and in-hospital mortality were chosen as study endpoints. The performance of EuroSCORE with and without pre- and/or postoperative cTnI were assessed by means of receiver operating characteristic curves, net reclassification index, and integrated discrimination improvement analyses. Data are expressed as ±SD. Results Death occurred in 28 of 905 (3%) patients and major adverse cardiac events in 202/905 (22%) patients. Models including EuroSCORE alone were characterized by a low discriminative power (c-index = 0.60 ± 0.05) in predicting major adverse cardiac events. The c-index increased to 0.61 ± 0.05 (P = 0.46), 0.70 ± 0.04 (P < 0.001), and 0.71 ± 0.04 (P < 0.001) when preoperative, postoperative, and pre/postoperative cTnI were included, respectively. The better predictive ability was confirmed by net reclassification index (0.41 ± 0.08, P < 0.001; 0.67 ± 0.08, P < 0.001; and 0.68 ± 0.08, P < 0.001, respectively) and integrated discrimination improvement (0.003 ± 0.002, P = 0.12; 0.099 ± 0.015, P < 0.001; and 0.094 ± 0.016, P < 0.001, respectively). Similar results were observed for in-hospital mortality. Conclusions The combination of EuroSCORE and postoperative cTnI provides the best discriminative power and performance in predicting adverse outcome after cardiac surgery and is suggested as being an effective model that improves early identification of high-risk patients.

scholarly journals Simultaneous Measurement of Cardiac Troponin I, B-type Natriuretic Peptide, and C-reactive Protein for the Prediction of Long-term Cardiac Outcome after Cardiac Surgery

2009 ◽  
Vol 111 (2) ◽  
pp. 250-257 ◽  
Author(s):  
Jean-Luc Fellahi ◽  
Jean-Luc Hanouz ◽  
Yannick Le Manach ◽  
Xavier Gué ◽  
Emmanuel Monier ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Natriuretic Peptide ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Major Adverse Cardiac Events ◽  
C Reactive Protein ◽  
Cardiac Events ◽  
Reactive Protein ◽  
Adverse Cardiac Events

Background Simultaneous assessment of cardiac troponin I, B-type natriuretic peptide, and C-reactive protein has been found to provide unique prognostic information in acute coronary syndromes. The current study addressed the prognostic implication of a multiple-marker approach in cardiac surgery. Methods Two hundred twenty-four patients undergoing cardiac surgery were included and followed up within 12 months after surgery. Serial blood samples were drawn in all patients the day before surgery, at the end of surgery, and 6, 24, and 120 h after surgery. Major adverse cardiac events within 12 months after surgery were chosen as study endpoints and were defined as malignant ventricular arrhythmia, myocardial infarction, congestive heart failure, the need for myocardial revascularization, and/or death from cardiac cause. Predictive ability of each cardiac biomarker was assessed using logistic regression. Results Accuracies of C-reactive protein, cardiac troponin I, and B-type natriuretic peptide, considered as continuous variables, to predict the occurrence of major adverse cardiac events were limited (area under receiver operating characteristic curve: 0.54 [0.47-0.60], P = 0.42; 0.62 [0.55-0.68], P = 0.01; and 0.68 [0.61-0.74], P < 0.001, respectively). When biomarkers were considered as 75% specificity dichotomized variables, elevated C-reactive protein (> 180 mg/l), cardiac troponin I (> 3.5 ng/ml), and B-type natriuretic peptide (> 880 pg/ml) were independent predictors of major adverse cardiac events (odds ratio: 2.14 [1.03-4.49], P = 0.043; 2.37 [1.25-5.64], P = 0.011; and 2.65 [1.16-4.85], P = 0.018, respectively) in a multivariate model including the European System for Cardiac Operative Risk Evaluation score. Conclusions Simultaneous measurement of cardiac troponin I, B-type natriuretic peptide, and C-reactive protein improves the risk assessment of long-term adverse cardiac outcome after cardiac surgery.

Cardiac risk assessment with the Revised Cardiac Risk Index index before elective non-cardiac surgery: A retrospective audit from an Australian tertiary hospital

2021 ◽  
pp. 0310057X2110246
Author(s):  
Yao Yao ◽  
Ashok Dharmalingam ◽  
Cyril Tang ◽  
Harrison Bell ◽  
Andrew DJ McKeown ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Risk Index ◽  
Cardiac Risk ◽  
Tertiary Hospital ◽  
Major Adverse Cardiac Events ◽  
Cardiac Complications ◽  
Cardiac Events ◽  
Prognostic Accuracy ◽  
Cardiac Risk Index ◽  
Adverse Cardiac Events

Clinicians assessing cardiac risk as part of a comprehensive consultation before surgery can use an expanding set of tools, including predictive risk calculators, cardiac stress tests and measuring serum natriuretic peptides. The optimal assessment strategy is unclear, with conflicting international guidelines. We investigated the prognostic accuracy of the Revised Cardiac Risk Index for risk stratification and cardiac outcomes in patients undergoing elective non-cardiac surgery in a contemporary Australian cohort. We audited the records for 1465 consecutive patients 45 years and older presenting to the perioperative clinic for elective non-cardiac surgery in our tertiary hospital. We calculated individual Revised Cardiac Risk Index scores and documented any use of preoperative cardiac tests. The primary outcome was any major adverse cardiac events within 30 days of surgery, including myocardial infarction, pulmonary oedema, complete heart block or cardiac death. Myocardial perfusion imaging was the most common preoperative stress test (4.2%, 61/1465). There was no routine investigation of natriuretic peptide levels for cardiac risk assessment before surgery. Major adverse cardiac events occurred in 1.3% (18/1366) of patients who had surgery. The Revised Cardiac Risk Index score had modest prognostic accuracy for major cardiac complications, area under receiver operator curve 0.73, 95% confidence interval 0.60 to 0.86. Stratifying major adverse cardiac events by the Revised Cardiac Risk Index scores 0, 1, 2 and 3 or greater corresponded to event rates of 0.6% (4/683), 0.8% (4/488), 4.1% (6/145) and 8.0% (4/50), respectively. The Revised Cardiac Risk Index had only modest predictive value in our single-centre experience. Patients with a revised cardiac risk index score of 2 or more had an elevated risk of early cardiac complications after elective non-cardiac surgery.

scholarly journals Detectable Cardiac Troponin I Predicts Adverse Cardiac Events and Heart Failure Hospitalizations in Stable Heart Failure Outpatients

2015 ◽  
Vol 21 (8) ◽  
pp. S119
Author(s):  
Muhammad Hammadah ◽  
Vasiliki Georgiopoulou ◽  
Andreas Kalogeropoulos ◽  
Javed Butler ◽  
W.H.Wilson Tang
Keyword(s):  
Heart Failure ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Cardiac Events ◽  
Adverse Cardiac Events
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