The Prognostic Significance of Postoperative High-Sensitivity Troponin I in Acute Type A Aortic Dissection

Abstract

Abstract Background Acute type A aortic dissection (ATAAD) is a life-threatening condition requiring urgent surgical intervention. Despite advancements in surgical techniques, identifying reliable postoperative prognostic markers remains essential for optimizing patient outcomes. This study aimed to investigate the association between initial postoperative High-Sensitivity Troponin I (hs-cTnI) levels and short- to long-term prognosis in patients undergoing surgery for ATAAD. Methods A retrospective analysis was conducted on 384 patients diagnosed with ATAAD between March 2019 and March 2022. The hs-cTnI and other clinical features were collected and subjected to logistic and Cox regression analyses. The patients were stratified based on their initial postoperative hs-cTnI levels, with a cut off value of 1.54. Results The findings demonstrate that higher initial postoperative hs-cTnI ≥ 1.54 were independently associated with increased in-hospital mortality within 30 days post-surgery (OR: 1.505; 95% CI: 1.327, 1.704; p < 0.001). Mortality rates were consistently higher in the hs-cTnI ≥ 1.54 group at 30 days, 90 days, 1 year, and 4 years post-surgery (p < 0.001 for all). hs-cTnI ≥ 1.54 group showed higher incidences of gastrointestinal bleeding (p = 0.008), cerebral infarction (p = 0.039), endotracheal intubation (p < 0.001), and CRRT (p < 0.001). Gender disparities were observed in hs-cTnI levels, with male overrepresentation and reduced female representation in the hs-cTnI ≥ 1.54 group. High-Sensitivity Troponin I exhibited good specificity, sensitivity, and AUC for predicting short-term mortality. These findings emphasize the prognostic value of initial postoperative hs-cTnI levels and shed light on their utility for risk assessment and clinical decision-making. Conclusion This study underscores the clinical significance of early postoperative hs-cTnI monitoring in patients undergoing surgery for ATAAD. Elevated initial postoperative hs-cTnI levels are associated with increased short- and long-term mortality rates, as well as specific postoperative complications.