loading page

Usefulness of postoperative high-sensitive troponin T measurement and implications for defining type 5 infarction
  • +3
  • Lars Niclauss,
  • Raymond Pfister ,
  • Dominique Delay ,
  • Piergiorgio Tozzi,
  • Matthias Kirsch,
  • rené prêtre
Lars Niclauss

Corresponding Author:lars.niclauss@chuv.ch

Author Profile
Raymond Pfister
Author Profile
Dominique Delay
Hopital du Valais
Author Profile
Piergiorgio Tozzi
Centre Hospitalier Universitaire Vaudois
Author Profile
Matthias Kirsch
Centre Hospitalier Universitaire Vaudois
Author Profile
rené prêtre
Author Profile


Background and aim of the study Guidelines on myocardial revascularization indicate for type V myocardial infarction (MI) that postoperative troponin elevations need not be exclusively ischemic but may also be caused by direct epicardial injury. Additional complexity arises from the introduction of high-sensitive troponin markers. The present study attempts to contribute to the understanding of postoperative high-sensitive cardiac troponin T (hs-cTnT) increase. Methods Type of surgery, potential factors affecting the postoperative hs-cTnT increase, and possible thresholds indicative of type V MI were analyzed. Results Among 400 included patients, 2.8% had intervention-related ischemia analogous to the type V MI definition. Receiver-operating characteristics confirmed good discriminatory power for hs-cTnT and creatine kinase myocardial band (CK-MB), with ischemia indicating thresholds for hs-cTnT (1705.5 ng/l) and for CK-MB (113 U/l). The median postoperative hs-cTnT/CK-MB increase differed significantly depending on the type of surgery, with the highest increase after mitral valve and the lowest after off-pump coronary surgery. Regression analysis confirmed Maze procedure (p<0.001), cardiopulmonary bypass time (p=0.03), emergency indications (p= 0.01) and blood transfusion (p=0.02) as significant factors associated with hs-cTnT increase. In contrast, CK-MB increase was also associated with mortality (p=0.002). Intra-pericardial defibrillation was the only ischemia-independent factor additionally associated with proposed thresholds (p<0.001). Conclusions The present results confirm the influence of the type of surgery and other intervention-related parameters on the postoperative hs-cTnT increase. Type V MI-indicating thresholds may require reassessment, especially using high-sensitive markers.
31 May 2021Submitted to Journal of Cardiac Surgery
31 May 2021Submission Checks Completed
31 May 2021Assigned to Editor
04 Jun 2021Reviewer(s) Assigned
16 Jul 2021Review(s) Completed, Editorial Evaluation Pending
16 Jul 2021Editorial Decision: Revise Major
12 Aug 20211st Revision Received
13 Aug 2021Submission Checks Completed
13 Aug 2021Assigned to Editor
20 Sep 2021Reviewer(s) Assigned
04 Oct 2021Review(s) Completed, Editorial Evaluation Pending
05 Oct 2021Editorial Decision: Accept
Jan 2022Published in Journal of Cardiac Surgery volume 37 issue 1 on pages 151-161. 10.1111/jocs.16105