Prognostic Implications of Preoperative hs-cTnT in Elective Coronary Artery Bypass Grafting

JACC advances Pub Date : 2025-09-23 DOI:10.1016/j.jacadv.2025.102180

Leo Pölzl MD, PhD , Joseph Kletzer MD , Ronja Lohmann MD , Christian Sutter MD , Maria Ioannou-Nikolaidou MD , Clemens Engler MD , Michael Graber MD, PhD , Felix Nägele MD , Jakob Hirsch MD , Samuel Heuts MD , Martin Czerny MD , Sebastian J. Reinstadler MD, PhD , Johannes Holfeld MD , Michael Grimm MD , Albi Fagu MD , Maximilian Kreibich MD , Tau Hartikainen MD , Nikolaos Bonaros MD , Tim Berger MD , Can Gollmann-Tepeköylü MD, PhD

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Abstract

Background

Elevated preoperative hs-cTnT may reflect underlying myocardial vulnerability, potentially influencing surgical timing and perioperative strategies in patients undergoing elective coronary artery bypass grafting (CABG).

Objectives

This study investigates the association between preoperative hs-cTnT levels, perioperative outcomes, and long-term mortality, aiming to improve risk stratification and guide clinical decision-making.

Methods

This retrospective study analyzed a consecutive series of 5,450 patients undergoing CABG at 2 tertiary centers between 2010 and 2023. Patients were categorized into 3 groups based on preoperative hs-cTnT levels: 1) nonelevated (<1x upper reference limit [URL]); 2) mildly elevated (1–3x URL); and 3) significantly elevated (>3x URL). A propensity score weighting method was performed before evaluating the association of hs-cTnT with perioperative outcomes, 30-day mortality and 5-year mortality.

Results

Among elective CABG patients, 26.6% had hs-cTnT levels >1x URL, and 12.4% had levels >3x URL. Patients with significantly elevated hs-cTnT (>3x URL) demonstrated increased risks of extracorporeal membrane oxygenation use (HR: 2.96 [95% CI: 1.81-4.84]), hemofiltration (HR: 2.99 [95% CI: 2.27-3.94]), and 5-year mortality (HR: 1.55 [95% CI: 1.28-1.86]) (all P < 0.001). Even mild elevations (1–3x URL) were linked to higher rates of hemofiltration (HR: 2.25 [1.75-2.90]; P < 0.001), extracorporeal membrane oxygenation use (HR: 1.65 [95% CI: 1.01-2.69]; P = 0.046), and 5-year mortality (HR: 1.37 [95% CI: 1.14-1.34]; P < 0.001).

Conclusions

Preoperative hs-cTnT is an independent predictor of adverse outcomes in elective CABG. Integrating hs-cTnT into routine preoperative assessment could identify high-risk patients, optimize surgical timing, and determine whether patients may benefit more from CABG or percutaneous coronary intervention, ultimately improving clinical outcomes.

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选择性冠状动脉旁路移植术术前hs-cTnT的预后意义

背景术前hs-cTnT升高可能反映潜在的心肌易损，可能影响择期冠状动脉旁路移植术（CABG）患者的手术时机和围手术期策略。目的探讨术前hs-cTnT水平、围手术期结局和远期死亡率之间的关系，旨在改进风险分层，指导临床决策。方法本回顾性研究分析了2010年至2023年在2个三级中心连续接受CABG的5450例患者。根据术前hs-cTnT水平将患者分为3组：1)未升高（参考上限1倍[URL]）；2)轻度升高（1-3x URL）；3)显著升高（>3x URL）。在评估hs-cTnT与围手术期结局、30天死亡率和5年死亡率的关系之前，采用倾向评分加权法。结果在选择性CABG患者中，26.6%的患者hs-cTnT水平为1倍URL， 12.4%的患者hs-cTnT水平为3倍URL。hs-cTnT （>3x URL）显著升高的患者显示体外膜氧合使用的风险增加（HR: 2.96 [95% CI: 1.81-4.84]），血液滤过（HR: 2.99 [95% CI: 2.27-3.94]）和5年死亡率（HR: 1.55 [95% CI: 1.28-1.86]）（均P <； 0.001）。即使是轻度升高（1-3x URL）也与较高的血液滤过率（HR: 2.25 [1.75-2.90]; P < 0.001）、体外膜氧合使用（HR: 1.65 [95% CI: 1.01-2.69]; P = 0.046）和5年死亡率（HR: 1.37 [95% CI: 1.14-1.34]; P < 0.001）有关。结论术前hs-cTnT是选择性冠脉搭桥不良结局的独立预测指标。将hs-cTnT纳入常规术前评估可以识别高危患者，优化手术时机，并确定患者是否从冠脉搭桥或经皮冠状动脉介入治疗中获益更多，最终改善临床结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC advances Cardiology and Cardiovascular Medicine

CiteScore

1.90

自引率

0.00%

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