Diagnostic And Prognostic Value Of Cardiac Biomarkers For Early Coronary Bypass Occlusion In Patients Undergoing Coronary Revascularization

Perioperative myocardial infarction (PMI) is a serious complication following coronary artery bypass grafting (CABG), with early graft occlusion accounting for 5–17% of cases. Early graft failure is often clinically silent, and current detection often occurs only after complications have developed. While invasive coronary angiography is the diagnostic standard, its associated risks (stroke, bleeding, nephropathy) limit its use to patients with overt clinical suspicion, leading to an underestimation of the incidence of early graft failure, including silent ones. There is a critical need for a validated, non-invasive diagnostic algorithm to stratify risk and guide early therapeutic intervention.

This prospective, single-center cohort study evaluates the diagnostic accuracy of serial cardiac biomarkers and imaging in detecting early silent graft occlusion after CABG. The primary objective is to determine the predictive value of high-sensitivity cardiac troponin T (hs-cTnT) and high-sensitivity cardiac troponin I (hs-cTnI) kinetics for early graft occlusion. Secondary endpoints include Major Adverse Cardiac and Cerebrovascular Events (MACCE) at 12 and 36 months, postoperatively.

Overall, the study will enroll 750 patients undergoing isolated CABG at the University Hospital Basel. The study leverages Coronary Computed Tomography (CT), a high-sensitivity, minimally invasive modality, as the reference standard for assessing graft patency on postoperative day 5. Investigational cardiac biomarkers will be assessed serially (7 measurements: pre-op, 6 hours postopreatively, day 1 to day 5, postoperatively) alongside daily ECGs and pre/post-operative transthoracic echocardiogram (TTE). 

This study seeks to validate a non-invasive diagnostic algorithm by correlating biomarker cut-offs and imaging criteria with CT-verified graft patency, thereby enabling early identification of patients requiring re-intervention.