Prospective, Comprehensive Assessment of Cardiac Troponin T Testing After Coronary Artery Bypass Graft Surgery

Abstract Background Ischemic myocardial damage accompanying coronary artery bypass graft surgery remains a clinical challenge. We investigated whether xenon anesthesia could limit myocardial damage in coronary artery bypass graft surgery patients, as has been reported for animal ischemia models. Methods In 17 university hospitals in France, Germany, Italy, and The Netherlands, low-risk elective, on-pump coronary artery bypass graft surgery patients were randomized to receive xenon, sevoflurane, or propofol-based total intravenous anesthesia for anesthesia maintenance. The primary outcome was the cardiac troponin I concentration in the blood 24 h postsurgery. The noninferiority margin for the mean difference in cardiac troponin I release between the xenon and sevoflurane groups was less than 0.15 ng/ml. Secondary outcomes were the safety and feasibility of xenon anesthesia. Results The first patient included at each center received xenon anesthesia for practical reasons. For all other patients, anesthesia maintenance was randomized (intention-to-treat: n = 492; per-protocol/without major protocol deviation: n = 446). Median 24-h postoperative cardiac troponin I concentrations (ng/ml [interquartile range]) were 1.14 [0.76 to 2.10] with xenon, 1.30 [0.78 to 2.67] with sevoflurane, and 1.48 [0.94 to 2.78] with total intravenous anesthesia [per-protocol]). The mean difference in cardiac troponin I release between xenon and sevoflurane was −0.09 ng/ml (95% CI, −0.30 to 0.11; per-protocol: P = 0.02). Postoperative cardiac troponin I release was significantly less with xenon than with total intravenous anesthesia (intention-to-treat: P = 0.05; per-protocol: P = 0.02). Perioperative variables and postoperative outcomes were comparable across all groups, with no safety concerns. Conclusions In postoperative cardiac troponin I release, xenon was noninferior to sevoflurane in low-risk, on-pump coronary artery bypass graft surgery patients. Only with xenon was cardiac troponin I release less than with total intravenous anesthesia. Xenon anesthesia appeared safe and feasible.

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222 Prognostic value of high-sensitivity cardiac troponin I early after coronary artery bypass graft surgery

European Heart Journal Supplements ◽

10.1093/eurheartj/suab140.027 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Samuele Nanni ◽

Anna Corsini ◽

Mattia Garofalo ◽

Matteo Schinzari ◽

Elena Nardi ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Cardiac Troponin ◽

Artery Bypass ◽

Bypass Graft ◽

High Sensitivity ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Artery Bypass Graft

Abstract Aims The diagnosis of periprocedural myocardial infarction (PMI) after coronary artery bypass graft (CABG) is based on biochemical markers along with clinical and/or instrumental findings. However, there is not a clear cut-off value of high-sensitivity cardiac troponin (hs-cTn) to identify PMI. We hypothesized that isolated hs-cTn concentrations in the first 24 h following CABG could predict cardiac adverse events (in-hospital death and PMI) and/or left ventricular ejection fraction (LVEF) decrease. Methods and results We retrospectively enrolled all consecutive adult patients undergoing CABG at our Institution over 1 year. Hs-cTnI concentrations (Access assay, Beckman-Coulter) were serially measured in the post-operative period and correlated with post-operative outcomes. 300 patients were enrolled; 71.3% of them underwent CABG alone, mainly on-pump (96.7%), 33.7% in the setting of an acute coronary syndrome. Most patients showed hs-cTnI values superior to the limit required by the latest guidelines for the diagnosis of PMI. Five patients (1.7%) died, 8% developed a PMI, and 10.6% showed a LVEF decrease ≥10%. Hs-cTnI concentrations did not correlate with death or PMI whereas they did correlate with LVEF decrease ≥ 10% (P-value < 0.05 at any time interval). Indeed, higher hs-cTnI values at 9–12 h post-operatively, along with previous cardiac surgery, number of surgical procedures, longer cardiopulmonary bypass time, and PMI diagnosis were predictors of LVEF decrease. Conclusions After CABG surgery, hs-cTnI at 9–12 h post-operatively may be a useful method to early identify patients at risk for LVEF decrease and to guide early investigation and management of possible post-operative complications.

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