Perioperative cardiac troponin as a predictor of post-operative atrial fibrillation in adult patients undergoing cardiac surgery: A systematic review and meta-analysis.

Abstract

Postoperative atrial fibrillation (POAF) is a frequent complication following cardiac surgery, contributing to increased morbidity and mortality. Identifying reliable biomarkers for early risk stratification remains a clinical priority. Cardiac troponins, as sensitive indicators of myocardial injury, have been investigated for their potential role in predicting POAF, though findings remain inconsistent across studies. A comprehensive literature search of PubMed, Web of Science, Embase, and ProQuest databases was conducted from inception to February 2026. Observational studies assessing preoperative or postoperative troponin levels and reporting POAF outcomes were included. Data were pooled using a random-effects model to calculate standardized mean differences (SMD) with 95% confidence intervals (CI). Thirteen studies comprising 5,258 patients were included. Patients who developed POAF had significantly higher preoperative troponin levels (SMD = 0.39; 95% CI: 0.035–0.746; p = 0.031) and postoperative troponin levels (SMD = 0.479; 95% CI: 0.024–0.935; p = 0.039) compared to those without POAF. High-sensitivity troponin assays demonstrated stronger associations with POAF than conventional assays. Sensitivity analyses confirmed the robustness of findings, and no significant publication bias was detected. Elevated perioperative cardiac troponin may be associated with an increased risk of POAF following cardiac surgery. These findings support the potential utility of troponin as a prognostic biomarker for POAF. • Post-operative atrial fibrillation (POAF) is a common condition and is linked to increased morbidity, mortality, and healthcare burden. • Perioperative cardiac troponin reflects myocardial injury and may help predict POAF risk. • The meta-analysis included 13 studies (n=5,258 patients). Elevated preoperative and postoperative troponin levels were associated with increased risk of POAF. • High-sensitivity troponin assays demonstrated stronger associations than conventional assays. • Troponin assessment may improve perioperative risk stratification for POAF.