Evaluation of the prognostic role of plasma HS-TROPONIN T and NT-PROBNP levels in predicting major adverse events in patients undergoing coronary artery bypass graft surgery

Objective: To evaluate the prognostic value of post -operative plasma high-sensitivity troponin T (hs-TnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for predicting major adverse events (MAEs) in patients undergoing coronary artery bypass grafting (CABG). Methods: A prospective, cross-sectional, self-controlled study was conducted on patients undergoing isolated on-pump CABG at Hanoi Heart Hospital from August 2024 to February 2025. Clinical and biochemical parameters were collected preoperatively, intraoperatively, and postoperatively. MAEs recorded until hospital discharge included: prolonged inotropic/vasopressor support >48 hours, mechanical circulatory support (intra-aortic balloon pump [IABP] or extracorporeal membrane oxygenation [ECMO]), arrhythmias, stroke, renal replacement therapy, ICU stay ≥5 days, and in-hospital mortality or discharge in critical condition. Patients were classified into two groups based on the occurrence of MAEs. The predictive values of perioperative hs-TnT and NT-proBNP levels were analyzed. Results: NT-proBNP levels on postoperative days 1 and 2 showed good predictive ability for overall MAEs, with areas under the ROC curve (AUC) of 0.702 (95% CI: 0.625–0.778; cut-off: 2827) and 0.732 (95% CI: 0.658–0.805; cut-off: 3187), respectively. hs-TnT levels immediately after surgery, and on postoperative days 1 and 2 demonstrated acceptable predictive value, with AUCs of 0.615 (95% CI: 0.531–0.699), 0.665 (95% CI: 0.584–0.746), and 0.644 (95% CI: 0.561–0.726), respectively. The two most frequent adverse events—prolonged inotropic/vasopressor use (>48 hours) and ICU stay ≥5 days—were best predicted by NT-proBNP on postoperative day 2, with AUCs of 0.810 (95% CI: 0.746–0.875) and 0.788 (95% CI: 0.702–0.875), respectively. Conclusion: Postoperative NT-proBNP and hs-TnT levels are valuable biomarkers for early prediction of major perioperative complications in patients undergoing CABG.