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Cardiac troponin release following coronary artery bypass grafting: mechanisms and clinical implications

Heuts, Samuel; Gollmann-Tepekoeylue, Can; Denessen, Ellen JS; Olsthoorn, Jules R; Romeo, Jamie LR; Maessen, Jos G; van't Hof, Arnoud WJ; ... Mingels, Alma MA; + view all (2022) Cardiac troponin release following coronary artery bypass grafting: mechanisms and clinical implications. European Heart Journal , Article ehac604. 10.1093/eurheartj/ehac604. Green open access

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Abstract

The use of biomarkers is undisputed in the diagnosis of primary myocardial infarction (MI), but their value for identifying MI is less well studied in the postoperative phase following coronary artery bypass grafting (CABG). To identify patients with periprocedural MI (PMI), several conflicting definitions of PMI have been proposed, relying either on cardiac troponin (cTn) or the MB isoenzyme of creatine kinase, with or without supporting evidence of ischaemia. However, CABG inherently induces the release of cardiac biomarkers, as reflected by significant cTn concentrations in patients with uncomplicated postoperative courses. Still, the underlying (patho)physiological release mechanisms of cTn are incompletely understood, complicating adequate interpretation of postoperative increases in cTn concentrations. Therefore, the aim of the current review is to present these potential underlying mechanisms of cTn release in general, and following CABG in particular (Graphical Abstract). Based on these mechanisms, dissimilarities in the release of cTnI and cTnT are discussed, with potentially important implications for clinical practice. Consequently, currently proposed cTn biomarker cut-offs by the prevailing definitions of PMI might warrant re-assessment, with differentiation in cut-offs for the separate available assays and surgical strategies. To resolve these issues, future prospective studies are warranted to determine the prognostic influence of biomarker release in general and PMI in particular.

Type: Article
Title: Cardiac troponin release following coronary artery bypass grafting: mechanisms and clinical implications
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/eurheartj/ehac604
Publisher version: https://doi.org/10.1093/eurheartj/ehac604
Language: English
Additional information: © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Keywords: Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Cardiovascular System & Cardiology, Cardiac troponin, Coronary artery bypass grafting, Cardiac surgery, Myocardial infarction, Periprocedural myocardial infarction, ACUTE MYOCARDIAL-INFARCTION, HIGHLY SENSITIVE ASSAY, CREATINE-KINASE-MB, CARDIOPULMONARY BYPASS, T RELEASE, CELL-DEATH, UNIVERSAL DEFINITION, VOLATILE ANESTHETICS, CARDIOPLEGIC ARREST, I DEGRADATION
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Pre-clinical and Fundamental Science
URI: https://discovery.ucl.ac.uk/id/eprint/10160757
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