Can Postoperative Troponin I Levels Adequate for Cardiac Surgery Risk Stratification?

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hs-cTnI may serve as a prognostic biomarker after CV and TA surgery. A single-center registry from Germany analyzed outcomes in 4,232 adults who underwent elective CV or TA procedures without CABG between 2013 and 2019.

Peak postoperative hs-cTnI levels exceeding 282× ULN were associated with higher long-term mortality (hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.00–1.24), while values above 194× ULN predicted 30-day mortality (HR 1.25; 95% CI 1.01–1.55). Predictive performance remained limited, with AUCs of 0.56 and 0.55 for long-term and 30-day mortality, respectively.

The results suggest that although elevated hs-cTnI indicates increased postoperative risk, standard myocardial infarction thresholds may not apply to surgical patients. Developing procedure-specific hs-cTnI cutoffs could enhance perioperative monitoring and individualized risk stratification in cardiac surgery.

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Key highlights

In 4,232 patients undergoing elective cardiac valvular (CV) or thoracic aortic (TA) surgery without coronary artery bypass grafting (CABG), elevated hs-cTnI levels were independently associated with 30-day and long-term mortality.
Thresholds of 194× and 282× the upper limit of normal (ULN) predicted short- and long-term mortality, respectively.
Predictive accuracy was modest, with area under the curve (AUC) values of 0.55 to 0.56, indicating limited discrimination.
Findings highlight the need for surgery-specific hs-cTnI thresholds to improve perioperative risk assessment.

Source

Rudolph F, Deutsch MA, Friedrichs KP, et al. Prognostic value of high-sensitivity cardiac troponin I after isolated non-CABG cardiac surgery. Clin Res Cardiol. Published online October 27, 2025. doi:10.1007/s00392-025-02771-9

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