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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

Fellahi, J.-L.*; Hanouz, J.-L.; Gué, X.*; Monier, E.*; Guillou, L.*; Riou, B.

European Journal of Anaesthesiology (EJA): June 2008 - Volume 25 - Issue 6 - p 490–497
doi: 10.1017/S0265021508003827
Original Article

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.

*Centre Hospitalier Privé Saint-Martin, Departments of Anesthesiology, Biology, Cardiothoracic Surgery, Caen, Paris, France

Centre Hospitalier Régional Universitaire, Department of Anesthesiology, Critical Care and Prehospital Medicine, Caen, Paris, France

CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Department of Emergency Medicine, Paris, France

Correspondence to: Jean-Luc Fellahi, Service d'Anesthésie Réanimation, CHP Saint-Martin, 18 rue des Roquemonts, 14050 Caen Cedex 4, France. E-mail:; Tel: +33 231 433 120; Fax: +33 231 433 124.

Accepted for publication 24 January 2008

First published online 13 March 2008

© 2008 European Society of Anaesthesiology