Impact of preoperative troponin levels on cardiac function following coronary surgery for myocardial infarction

Abstract

To the Editor, Troponin elevation before coronary revascularization is associated with mortality and morbidity. However, the clinical implication of peak troponin level measured before coronary surgery remains controversial. Hess et al. demonstrated that preoperative peak troponin level was not associate with clinical outcomes following coronary surgery. Several concerns have been raised. The methodology to measure peak troponin level is unclear. Troponin is, in general, measured only once or twice before the intervention. It might be unclear whether the value stated in their study is peak or not. Patients without any troponin leak were excluded, and the implication of elevated troponin level might have been diluted. In addition to the peak troponin level, the duration between the onset and intervention would also be important to consider cumulative leakage of troponin as well as myocardial damage. In addition to the major adverse cardiac and cerebrovascular events, cardiac remodeling and heart failure recurrence due to ischemic cardiomyopathy is another concern following cardiac surgery for myocardial infarction. The follow‐up echocardiographic data and heart failure readmission rate would also be important clinical outcomes. For such analyses, medications including beta‐blockers and renin‐angiotensin system inhibitors are critical confounders that should be adjusted for. CONFLICT OF INTERESTS Teruhiko Imamura receives grant support from JSPS KAKENHI: JP20K17143.