Predictive Value and Implications of Cardiac Troponins and Timing in Coronary Artery Bypass Surgery With Acute Coronary Syndromes.

Abstract

Cardiac troponin (cTn) I and T on admission as well as timing to surgery have been suggested as independent predictors for adverse outcomes in patients with acute coronary syndromes (ACS) undergoing coronary artery bypass grafting (CABG). We therefore sought to evaluate the association and predictive value of timing to surgery together with preoperative cTnI and T on a multicenter basis. A total of 3114 patients with ACS who underwent CABG between January 2010 and March 2023 were prospectively entered into a multicentric registry. Key end points were in-hospital mortality (IHM) and major adverse cardiac and cerebrovascular events (MACCE). CTnI or T levels were increased on admission between survivors and nonsurvivors (6.0 vs 16.6 ng/mL, P < .001; and 0.8 vs 1.2 ng/mL, P < .001). Timing between symptom onset and CABG was within ≤6 hours in 5.6% of patients, >6 to ≤24 hours in 18.4%, >24 to ≤72 hours in 32.2%, and >72 hours in 43.8%. IHM and MACCE were highest for patients operated on within ≤6 hours (20.6% and 39.2%) but decreased with increase in timing (P < .001). Multivariable logistic regression analysis revealed preoperative cTnI and time to surgery as strong and independent predictors of IHM and MACCE. Higher cTnI levels were associated with decreased survival and lower freedom from MACCE with immediate surgery but inversely increased with delayed time to surgery. High preoperative cTnI or T levels associated with immediate surgery are closely related to unfavorable outcomes in patients undergoing bypass surgery for ACS. Patients with elevated troponin levels may benefit from delaying surgery, as long as the patient's hemodynamics remain stable.