Early Troponin T and Prediction of Potentially Correctable In-Hospital Complications after Coronary Artery Bypass Grafting SurgeryReportar como inadecuado




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Background

Peak levels of troponin T TnT reliably predict morbidity and mortality after cardiac surgery. However, the therapeutic window to manage CABG-related in-hospital complications may close before the peak is reached. We investigated whether early TnT levels correlate as well with complications after coronary artery bypass grafting CABG surgery.

Methods

A 12 month consecutive series of patients undergoing elective isolated CABG procedures mini-extra-corporeal circuit, Cardioplegic arrest was analyzed. Logistic regression modeling was used to investigate whether TnT levels 6 to 8 hours after surgery were independently associated with in-hospital complications either post-operative myocardial infarction, stroke, new-onset renal insufficiency, intensive care unit ICU readmission, prolonged ICU stay >48 hours, prolonged need for vasopressors >24 hours, resuscitation or death.

Results

A total of 290 patients, including 36 patients with complications, was analyzed. Early TnT levels odds ratio OR: 6.8, 95% confidence interval CI: 2.2-21.4, P=.001, logistic EuroSCORE OR: 1.2, 95%CI: 1.0-1.3, P=.007 and the need for vasopressors during the first 6 postoperative hours OR: 2.7, 95%CI: 1.0-7.1, P=.05 were independently associated with the risk of complications. With consideration of vasopressor use during the first 6 postoperative hours, the sum of specificity 0.958 and sensitivity 0.417 of TnT for subsequent complications was highest at a TnT cut-off value of 0.8 ng-mL.

Conclusion

Early TnT levels may be useful to guide ICU management of CABG patients. They predict clinically relevant complications within a potential therapeutic window, particularly in patients requiring vasopressors during the first postoperative hours, although with only moderate sensitivity.



Autor: Volkhard Göber, Andreas Hohl, Brigitta Gahl, Florian Dick , Verena Eigenmann, Thierry P. Carrel, Hendrik T. Tevaearai

Fuente: http://plos.srce.hr/



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