Cardiology
for September 30, 2009 SUMMARY AND
COMMENT Elevated
Troponin After Coronary Bypass Surgery: What Does It
Mean?
September
30, 2009 | Joel M.
Gore, MD
Observational findings suggest that very high TnT levels predict
adverse outcomes. Reviewing: Mohammed AA et al. Circulation 2009
Sep 8; 120:843
SUMMARY
AND COMMENT Coronary
Artery Bypass Grafting After Percutaneous Coronary
Intervention
September
30, 2009 | Howard
C. Herrmann, MD
Findings
from a large observational study support the safety of a "PCI first"
strategy in many patients. Reviewing: Yap C-H et al. JACC Cardiovasc
Interv 2009 Aug 2:758
Mack M. JACC Cardiovasc Interv 2009 Aug
2:765
SUMMARY
AND COMMENT Angiotensin-Receptor
Blockers for Microalbuminuria Free!
September
24, 2009 | Richard
Saitz, MD, MPH, FACP, FASAM
ARBs
didn't prevent adverse renal outcomes in patients with cardiovascular
disease or diabetes. Reviewing: Mann JFE et al. Ann Intern Med 2009
Jul 7; 151:1
Bilous R et al. Ann Intern Med 2009 Jul 7;
151:11
Parfrey PS. Ann Intern Med 2009 Jul 7;
151:63
SUMMARY
AND COMMENT Survival
to Discharge After Cardiac Arrest Free!
September
29, 2009 | Thomas
L. Schwenk, MD
Hospital
characteristics explain much of the lower survival rate that was noted
for black patients compared with white patients. Reviewing:
Chan PS et al. JAMA 2009 Sep 16; 302:1195
SUMMARY
AND COMMENT Radiofrequency
Catheter Ablation for Atrial Fibrillation
September
24, 2009 | Richard
Saitz, MD, MPH, FACP, FASAM
This
procedure is effective as a second-line treatment in selected
patients. Reviewing: Terasawa T et al. Ann Intern Med 2009 Aug 4;
151:191
SUMMARY
AND COMMENT Quantifying
the Benefit of Anticoagulation for Atrial Fibrillation
September
24, 2009 | Richard
Saitz, MD, MPH, FACP, FASAM
Half of
AF patients will benefit, half will not — risk stratification is a
vital component of decision making. Reviewing: Singer DE et al. Ann
Intern Med 2009 Sep 1; 151:297
Hart RG and Halperin JL. Ann Intern Med 2009
Sep 1; 151:355
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Summary
and Comment
Elevated Troponin After Coronary Bypass Surgery: What Does It Mean?Observational findings suggest that very high TnT levels predict
adverse outcomes. To assess the clinical significance of cardiac
troponin elevation after coronary artery bypass grafting, investigators
studied data on 847 consecutive patients who underwent isolated CABG at a
single U.S. institution. The median peak troponin T (TnT) level obtained
within 24 hours after surgery was 1.08 ng/mL. TnT levels were 0.15 ng/mL in 96.6% of patients,
and 36.7% had a TnT of 1.60
ng/mL. However, new Q waves or left bundle-branch block occurred in only 17
patients (2%) on the day after surgery.
Postoperative TnT levels correlated directly and significantly with
duration of intensive care unit stay, hours of postoperative mechanical
ventilation, and duration of hospital stay. The median peak TnT level
during the first 24 hours was significantly higher in the nine patients who
died within 30 days after CABG than in survivors (3.41 ng/mL vs. 1.07
ng/mL). Heart failure or death occurred in 18 patients; the median TnT
level in this group was significantly higher than in patients without
either outcome. In a multivariate analysis adjusted for the Society of
Thoracic Surgeons risk score, TnT values significantly predicted
postoperative death, death or heart failure, death or vasopressor
treatment, and the composite of death, heart failure, and vasopressor
treatment.
Comment: Elevated troponin T concentrations are seen in nearly
all patients after CABG. These results suggest that a marked TnT elevation
soon after bypass surgery does indicate a poor prognosis and that troponin
testing, although perhaps unnecessary in all patients after CABG, is useful
for assessing the clinical implications of delayed recovery. Efforts are
warranted to identify — and, ultimately, to prevent or treat —
the causes of TnT release during and after bypass surgery.
— Joel
M. Gore, MD
Published in Journal Watch Cardiology September 30,
2009
Citation(s):
Mohammed
AA et al. Prospective, comprehensive assessment of cardiac troponin T
testing after coronary artery bypass graft surgery.
Circulation
2009 Sep 8; 120:843. Original
article (Subscription may be required) Medline
abstract (Free)
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