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The prognostic value of troponin T for long-term outcome after cardiac surgery
| Third-party funded project |
| Project title |
The prognostic value of troponin T for long-term outcome after cardiac surgery |
| Principal Investigator(s) |
Filipovic, Miodrag
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| Co-Investigator(s) |
Seeberger-Stucky, Manfred
Bucher, Heiner
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| Organisation / Research unit |
Bereich Querschnittsfächer (Klinik) / Anästhesiologie |
| Project start |
01.05.2008 |
| Probable end |
31.12.2011 |
| Status |
Completed |
| Abstract |
Background: Measurements of troponin I or troponin T are used for diagnostic and prognostic purposes in a broad range of clinical situations. In cardiac surgery, the association between postoperatively elevated troponin levels and major adverse events is established for short-term (30 days) but not for long-term ( one year) outcome.
Working Hypothesis: A postoperative rise in cardiac troponin T is an independent risk marker for mortality and major adverse cardiac events within one year after cardiac surgery. Added to an established risk model (e.g., the EuroSCORE or the Society of Thoracic Surgeons (STS) score), monitoring troponin T levels will enhance the prediction of one-year mortality.
Specific Aims: To evaluate the prognostic value of increased troponin T levels after cardiac surgery for the prediction of mortality and major adverse cardiac events within 30 days and one year after surgery and to assess the suggested increase in prognostic accuracy of established risk models (e.g., the EuroSCORE or the STS score).
Methods: All consecutive patients who undergo cardiac surgery at the University Hospital Basel from January 2007 to December 2009 will be evaluated. Troponin T levels are routinely collected in all cardiac surgery patients on the first and second postoperative morning (6 a.m.). These data will be collected together with routine pre-operative risk assessment data (e.g., the EuroSCORE) and markers of peri-operative risk. In addition to morbidity and mortality assessment during hospitalisation, mortality and cardiac morbidity will be assessed within one year after surgery by direct contact with all patients and their family doctors, and by hospital chart review. Stratified analyses will be performed for patients undergoing CABG and valvular surgery and differences in prognostic accuracy will be studied across these subgroups. The principal goal of this cohort study is to determine the prognostic accuracy of troponin T to predict 30-day and one-year mortality after open-heart surgery; moreover, to study the incremental prognostic value of troponin T in order to update established pre-operative risk assessment (e.g., the EuroSCORE or the STS score) for short-term and long-term mortality prediction.
Expected Value of the Proposed Project: This study will provide information on the predictive value of troponin T levels after cardiac surgery for 30-day and one-year mortality. Knowledge of these levels is thought to improve peri-operative risk assessment. In addition, it is basis for an improved short- and long-term management, particularly of patients who have been thought to have a good prognosis based on preoperative risk evaluation, but who are identified as having an unfavourable prognosis based on troponin-supplemented risk evaluation. Strategies for intensified clinical observance and optimised treatment of these patients have to be developed and tested in the future. |
| Financed by |
Swiss National Science Foundation (SNSF)
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11/05/2024
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