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The prognostic value of troponin release after adult cardiac surgery - a meta-analysis

Lurati Buse, Giovanna A. and Koller, Michael T. and Grapow, Martin and Bolliger, Daniel and Seeberger, Manfred and Filipovic, Miodrag. (2010) The prognostic value of troponin release after adult cardiac surgery - a meta-analysis. European journal of cardio-thoracic surgery, Vol. 37, H. 2. pp. 399-406.

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Official URL: http://edoc.unibas.ch/dok/A6007442

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Abstract

To assess the accuracy of increased troponin (Tn) concentrations for the prediction of mid-term (< or = 12 months) mortality after coronary artery bypass graft (CABG) and valve surgery, we performed a systematic review identifying all studies reporting on the association between postoperative troponin release and mortality after cardiac surgery. Studies were identified through 30 April 2008 by electronic searches of the MEDLINE, EMBASE and BIOSIS databases. Two reviewers independently selected studies, assessed methodological quality and extracted the data. We primarily considered mid-term (< or = 12 months) and secondarily short-term (> or = 30 days) all-cause mortality. A bivariate random-effects model was used to study determinants and to pool measures of prognostic accuracy of Tn. Seventeen studies fulfilled the inclusion criteria with a total of 237 mid-term deaths in 5189 patients and 296 short-term deaths in 9703 patients. The diagnostic odds ratio of increased Tn concentrations was 5.46 (95% confidence interval (CI) 2.0-14.6) for mid-term mortality and 6.57 (95% CI 4.3-10.1) for short-term mortality after adult cardiac surgery. Alternatively expressed, for troponin elevation, the sensitivity was 0.45 (0.26-0.67) and the specificity 0.87 (0.73-0.90) to predict mid-term mortality. The sensitivity was 0.59 (0.48-0.69) and the specificity 0.82 (0.72-0.89) for short-term mortality. Between-study variability was high. In conclusion, this meta-analysis provides evidence for an association between postoperative Tn release with mid- and short-term all-cause mortality after adult cardiac surgery. However, differences in populations, timing of Tn testing, Tn subunit and Tn assays make definitive conclusions about effect size and cut-off values difficult.
Faculties and Departments:03 Faculty of Medicine > Bereich Querschnittsfächer (Klinik) > Anästhesiologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Querschnittsfächer (Klinik) > Anästhesiologie
03 Faculty of Medicine > Departement Klinische Forschung > Clinical Epidemiology and Biostatistics CEB > Klinische Epidemiologie (Bucher H)
UniBasel Contributors:Koller, Michael and Seeberger-Stucky, Manfred and Filipovic, Miodrag
Item Type:Article, refereed
Article Subtype:Further Journal Contribution
Bibsysno:Link to catalogue
Publisher:Oxford Univ. Press
ISSN:1010-7940
Note:Publication type according to Uni Basel Research Database: Journal item
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Last Modified:20 Jun 2014 07:55
Deposited On:20 Jun 2014 07:55

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