Using CK-MB and hs-cTnT to Predict 30-Day Mortality After CABG: A Combined Biomarker Risk-Stratification Approach
In brief
Top CK-MB and troponin marked nearly 15-fold higher death risk after bypass
In 9,856 patients after coronary bypass surgery, those with CK-MB and high-sensitivity troponin T both in the top tertile had nearly 15 times the adjusted 30-day mortality risk of the reference group. Each marker predicted mortality about as well on its own, but their combination identified distinct risk groups; whether this approach improves postoperative care remains to be tested.
- Journal
- JACC. Advances (Q1)
- Published
- 25 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Winter-Pölzl Leo, Kletzer Joseph, Lohmann Ronja, Engler Clemens, Nägele Felix, Graber Michael, et al.
- PMID
- 42790282
- DOI
- 10.1016/j.jacadv.2026.103284
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (paper of the day, 27 September 2026): CK‑MB and hs‑cTnT predict post‑CABG mortality
Abstract
BACKGROUND: Accurate diagnosis of perioperative myocardial infarction after coronary artery bypass grafting remains challenging due to uncertainty over postoperative cardiac biomarker interpretation. OBJECTIVES: The authors aimed to evaluate the prognostic value and performance of postoperative creatine kinase-myocardial band (CK-MB) and high-sensitivity cardiac troponin T (hs-cTnT) and explore a combined approach to identify patients at risk of early death. METHODS: This multicenter cohort study involved 9,856 patients undergoing isolated coronary artery bypass grafting at hospitals in Innsbruck, Freiburg, Gothenburg, and Reykjavik. A combined biomarker matrix was created to assess synergistic effects. Associations of biomarkers with 30-day all-cause mortality were evaluated using multivariable Cox regression (adjusted HR) and area under the receiver-operating curve (AUC) analysis. RESULTS: Thirty-day all-cause mortality was 2.0%. Median peak values within 72 hours postsurgery were 2.24 (Q1-Q3: 1.66-3.36) × upper reference limit for CK-MB and 52.06 (Q1-Q3: 29.79-90.00) × upper reference limit for hs-cTnT. Both postoperative CK-MB (adjusted HR: 1.95; 95% CI: 1.79-2.12; P < 0.001) and hs-cTnT (adjusted HR: 1.71; 95% CI: 1.61-1.82; P < 0.001) were associated with higher mortality risk per doubling in concentration independent of EuroSCORE II. Predictive accuracy of CK-MB and hs-cTnT was similar (AUC: 0.787 vs 0.784; P = 0.99), yet stratification using Youden-derived thresholds identified distinct patient subgroups with limited overlap. In a combined analysis, mortality risk was increased only when CK-MB was in the top tertile and hs-cTnT in the mid (adjusted HR: 4.34; 95% CI: 1.78-10.62; P < 0.001) or top tertile (adjusted HR: 14.78; 95% CI: 6.85-31.88; P < 0.001). CONCLUSIONS: The combined use of CK-MB and hs-cTnT enables a simple and robust risk-stratification strategy for early postoperative mortality, with direct implications for clinical surveillance and future cardiac surgery trials.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.