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

Year: 2025

Type: article

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.

Source: JACC Advances

DOI: 10.1016/j.jacadv.2025.102180