Author Interviews, Biomarkers, Heart Disease, NEJM / 03.03.2022
NEJM Study Evaluates Levels of hs Troponin after Cardiac Surgery and Risk of Death
MedicalResearch.com Interview with:
PJ Devereaux MD PhD
Professor of Medicine, and
of Health Research Methods, Evidence and Impact
McMaster University
President of the Society of Perioperative Research and Care
MedicalResearch.com: What is the background for this study?
Response: More than 1 million patients undergo cardiac surgery in the United States and Europe annually. Although cardiac surgery has the potential to improve and prolong a patient’s quality and duration of life, it is associated with complications. Prognostically important heart injury – detected by an elevated blood concentration of either cardiac troponin or creatine kinase myocardial MB isoform (CK-MB) – is one of the most common complications after cardiac surgery and is associated with increased mortality.
Although elevated CK-MB was historically used to define heart injury after cardiac surgery, this assay is no longer available in many hospitals worldwide, and consensus statements have recommended high-sensitivity cardiac troponin assays as the preferred biomarker. Based on expert opinion, the Fourth Universal Definition of Myocardial Infarction suggested that a cardiac troponin concentration >10 times the upper reference limit, in patients with a normal baseline measurement, should be the threshold used in the diagnosis of heart attack along with evidence of ischemia (e.g., ischemic ST changes on an ECG) in the first 48 hours after coronary artery bypass grafting (CABG). Although the Academic Research Consortium-2 Consensus stated there was no evidence-based threshold for cardiac troponin after CABG, they endorsed a threshold for the diagnosis of heart attack of ≥35 times the upper reference limit together with new evidence of ischemia, based on expert opinion. They also defined a threshold of ≥70 times the upper reference limit as a stand-alone criterion for clinically important periprocedural myocardial injury.
Globally, many hospitals now use high-sensitivity cardiac troponin assays; however, limited data are available to define a prognostically important degree of myocardial injury after cardiac surgery based on these assays. We undertook the Vascular Events in Surgery Patients Cohort Evaluation (VISION) Cardiac Surgery Study to examine clinical outcomes after cardiac surgery.
A primary objective was to determine the relationship between postoperative levels of high-sensitivity cardiac troponin I and the risk of death 30 days after cardiac surgery. (more…)
Amanda Paluch, PhD
Assistant Professor
University of Massachusetts Amherst
Department of Kinesiology
Institute for Applied Life Sciences
Life Science Laboratories
Amherst, MA 01003
MedicalResearch.com: What is the background for this study?
Response: We wanted to understand the association of total steps per day with premature mortality among middle-aged, Black and White women and men. This study included 2110 adults; age 38-50 years old at the start of this study. These adults wore a step counting device for one week and then followed for death from any cause over the next 10 years.
Anne Yuk-Lam Ho, MPH
Million Veteran Program (MVP) Data Core
MVP Coordinating Center
VA Boston Healthcare System
MedicalResearch.com: What is the background for this study?
Response: Cardiovascular disease (CVD) has been the leading cause of morbidity and mortality globally. Prevalence of CVD among US population is approximately 7% which places huge burden on our healthcare systems. And prevalence of CVD is as high as 28% among veterans at the VA healthcare system as veteran users are primarily older male with more histories of comorbidities. Most CVD risk factors including lipids and blood pressure can be controlled by lifestyle modifications, such as diet.
Chocolate is among dietary factors that play a role in modulating CVD risk factors is widely consumed in the US (~2.8 billion pounds annually. Although previous studies have reported beneficial effects of chocolate and/or cacao products (rich in flavonoids) on lipids, glucose metabolism and risk of diabetes, and lipids, little is known about the association of chocolate intake with coronary artery disease (CAD) among US veterans. Thus, sought to test the hypothesis that chocolate consumption is associated with a lower risk of CAD among xxx US veterans enrolled in the Million Veteran Program.