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The results of the present study extend the value of postoperative assessment of troponin T for the prediction
assessing troponin T for the prediction of mortality rate of in-hospital adverse outcome after coronary artery
1 year after coronary artery bypass grafting; this study bypass grafting. 䊚2004 by Excerpta Medica, Inc.
supports previous work that demonstrated the value of (Am J Cardiol 2004;94:879 – 881)
©2004 by Excerpta Medica, Inc. All rights reserved. 0002-9149/04/$–see front matter 879
The American Journal of Cardiology Vol. 94 October 1, 2004 doi:10.1016/j.amjcard.2004.06.022
TABLE 1 Baseline Characteristics of the Subjects (n ⫽ 136) TABLE 2 Cardiac Marker Levels at Different Time Points After
CABG, Expressed as a Function of Mortality (n ⫽ 7) Versus
Age (yrs) 67 ⫾ 12 No Mortality (n ⫽ 129)
Men 77%
Medical history Death No Death
Diabetes 34% Marker and Timing (n ⫽ 7) (n ⫽ 129) p Value
Systemic hypertension 75%
Hypercholesterolemia 86% Troponin T
Tobacco use 42% Postop 6.4 (1.3–10.7) 1.0 (0.60–1.5) 0.07
Coronary artery disease 67% 6–12 h 7.4 (2.0–9.8) 1.3 (0.76–1.9) 0.02
Previous acute myocardial infarction 35% 18–24 h 7.8 (3.6–16.1) 0.76 (0.42–1.26) 0.02
Valve disease 5% CK-MB
Congestive heart failure 15% Postop 79.6 (35–109) 42.2 (29–85) 0.50
Percutaneous coronary intervention 18% 6–12 h 77.9 (33–97) 47.2 (28–80) 0.40
Extent of coronary artery disease, vessels 2.6 ⫾ 0.7 18–24 h 46.0 (21–117) 21.6 (13–42) 0.12
Extent of coronary artery disease Data are presented as median (interquartile range) (in nanograms per
1 vessel 10% milliliter).
2 vessels 17%
3 vessels or left main artery 73%
Ejection fraction (%) 42 ⫾ 23
Presenting syndrome
Congestive heart failure 13%
in patients stratified by vital status are presented in
Unstable angina pectoris 39% Table 2.
Stable angina pectoris 18% In the patients who died during the 1-year follow-
Non–ST-segment elevation myocardial infarction 20% up, the immediate postop, 6- to 12-hour, and 18- to
ST-segment elevation myocardial infarction 9%
Cardiac arrest 2%
24-hour median (and interquartile ranges) levels of
Previous medication use troponin T were 6.4 ng/ml (1.3 to 10.7), 7.4 ng/ml (2.0
Aspirin 94% to 9.8), and 7.8 ng/ml (3.6 to 16.1), respectively,
 blocker 83% which were significantly higher than comparably
Statins 76% timed levels of troponin T in patients who survived:
Nitrates 69%
Heparin 39%
1.0 ng/ml (0.6 to 1.5), 1.3 ng/ml (0.76 to 1.9), and 0.76
Surgical details ng/ml (0.42 to 1.26), respectively. The differences in
Repeat surgery 8% levels of troponin T between patients who were alive
No. of vessels grafted 3.4 ⫾ 1.3 and those who were dead at 1 year were significant for
Data are presented as mean ⫾ SD or number (percentage). the 6- to 12- and 18- to 24-hour specimens (each p
⬍0.05). Identically timed CK-MB values did not dif-
fer significantly between patients who were alive and
those who were dead at 1 year.
year. The primary dependent variable was 1-year mor- Multivariable analysis suggested that an 18- to
tality rate. The primary independent variable was an 24-hour postoperative level of troponin T in the high-
increased level of troponin T in any of the 3 postop- est log quintile (ⱖ1.58 ng/ml) was the strongest pre-
erative samples. Other independent variables included dictor of a 1-year mortality rate (odds ratio 5.45, 95%
the results of CK-MB testing, demographics, present- confidence interval 4.5 to 232.5, p ⬍0.0001), whereas
ing syndrome, cardiovascular risk factors, medication CK-MB results added no independent information.
use, extent of CAD, ejection fraction, repeat CABG, Survival curves for patients with high levels (top
type of cardioplegia, and other clinical factors, as quintile in the 18- to 24-hour specimen) and low levels
described previously.4 Cox’s regression analysis used (quintiles 2 through 5 in the 18- to 24-hour specimen) of
forward stepwise regression. An independent variable troponin T are displayed in Figure 1. Most patients who
was removed from the model only when its corre- died were in the highest log quintile of troponin T.
sponding regression parameter was not significantly
different from 0 at p ⬎0.1. Cox’s regression analysis DISCUSSION
was conducted with BMDP 7 (BMDP Statistical Soft- In the present study, we describe for the first time a
ware, Inc., Saugus, Massachusetts). For all significant correlation between levels of troponin T after CABG and
covariates of event-free survival rate, 95% confidence longer term adverse outcomes. In univariate and multi-
intervals were computed. All p values were 2-sided, variable modeling, the level of troponin T after CABG
and a p value ⬍0.05 was considered statistically sig- was the single best predictor of mortality rate at 1 year
nificant. and was superior to CK-MB for this indication.
The clinical significance of release of cardiac bi-
RESULTS omarkers after cardiac procedures has been a subject
Of 136 patients, 2 (1.5%) were lost to follow-up. of controversy and has generally been defined by
The 2 patients lost to follow-up were imputed to be relating marker levels to clinical outcomes.5– 8 Two
alive and free of complications. Baseline demograph- recent studies have established a relation between
ics of the study patients are listed in Table 1 and are CK-MB after CABG and worsened medium-term out-
comparable to those in previous studies on outcomes comes.9,10 However, the sensitivity and specificity of
after CABG. Seven patients (5%) died during the CK-MB in the 2 analyses were limited. In previous
1-year follow-up. The mean levels of cardiac markers studies, troponin I was found to be superior to CK-MB