Recent clinical research on the value of high-sensitivity cardiac troponin levels in prognostic evaluation after coronary artery bypass graft surgery: a narrative review.

Abstract

Background and objective: Coronary artery bypass grafting (CABG) is an effective treatment for coronary artery disease, high risk of complications, making it particularly important to assess patient prognosis. High-sensitivity cardiac troponin (hs-cTn), as a key biomarker of myocardial injury, plays an important role in evaluating the prognosis of patients after CABG. However, the optimal threshold values for hs-cTn in the current guidelines are all artificially set, lacking a unified standard. This narrative review aims to fill the knowledge gap and provide new directions for future research. This is of significant importance for optimizing the management of patients after CABG, improving prognosis, and for developing more precise and personalized treatment strategies.

Methods: We conducted a structured search on PubMed, Web of Science MEDLINE and Cochrane Library using terms like "High-Sensitivity Cardiac Troponin", "Coronary Artery Bypass Grafting", "Prognosis", "Mortality", and "Postoperative Outcomes" to identify English-language studies from inception to 25 July 2024. This article systematically reviews recent studies on hs-cTn levels and prognostic risk factors after CABG, aiming to comprehensively sort out and analyze existing research findings.

Key content and findings: Studies show that the release of hs-cTnT and hs-cTnI is related to postoperative myocardial injury/infarction and short-term mortality, but there is still controversy in the conclusions regarding long-term mortality. In addition, different studies have drawn different conclusions about the application of hs-cTnI in postoperative myocardial infarction, restenosis, and hypoxemia, as well as its association with mortality. However, a common view is that the hs-cTn cutoff values used in current clinical practice are too conservative, which may limit the accuracy of its prognosis assessment.

Conclusions: Hs-cTn has significant value in the prognosis assessment of patients after CABG, but its clinical decision level often exceeds the critical values specified in the guidelines. In the future, more rigorous prospective multicenter trials need to be conducted in different populations to further determine the optimal diagnostic thresholds for hs-cTn, thereby improving the accuracy of prognosis assessment in patients after CABG.