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

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.