Paparella Domenico, Cappabianca Giangiuseppe, Visicchio Giuseppe, Galeone Antonella, Marzovillo Angelo, Gallo Nunzio, Memmola Cataldo, Schinosa Luigi de Luca Tupputi
Division of Cardiac Surgery, Dipartimento d'Emergenza e Trapianti d'Organo, Universitá di Bari, Bari, Italy.
Ann Thorac Surg. 2005 Nov;80(5):1758-64. doi: 10.1016/j.athoracsur.2005.04.040.
Markers of myocardial necrosis are usually elevated in patients who have undergone a coronary bypass operation with cardiac arrest. The preferred marker in detecting acute myocardial ischemia is cardiac troponin I (cTnI). However, its ability to predict short-term and, particularly, midterm outcome after coronary bypass operations is uncertain.
Two hundred thirty unselected patients undergoing surgical revascularization had cTnI measured preoperatively and 11 times postoperatively. Receiver operating characteristic curves were constructed using cTnI postoperative peak values in order to assess the prognostic sensitivity and specificity of the test. The cut-off value of 13 ng/mL was used to assess the prognostic significance of the peak cTnI postoperative release for short-term and midterm outcomes.
One hundred forty-six patients (63.5%) had postoperative cTnI peak values less than 13 ng/mL (mean peak value, 6.6 +/- 3.1 ng/mL) and 84 patients (36.5%) had postoperative cTnI peak values greater than 13 ng/mL (mean peak value, 45.5 +/- 59.9 ng/mL). Patients with peak cTnI greater than 13 ng/mL were older and had higher preoperative cTnI values. They required both longer cross-clamp time and CPB time. Moreover, hospital death in the cTnI greater than 13 ng/mL group (9.5% versus 0.7%, p = 0.0009) was significantly higher. Multivariate analysis showed that cTnI greater than 13 ng/mL was the only independent predictor of hospital death (odds ratio 10.33, p = 0.04) and hospital death from cardiac causes. A 2-year follow-up demonstrates that cTnI postoperative release had no influence on midterm mortality and hospitalization for due to cardiac illness.
Cardiac troponin I is a valuable marker for immediate myocardial damage after coronary bypass operations. Its postoperative release does not predict midterm outcome.
在接受心脏停搏冠状动脉搭桥手术的患者中，心肌坏死标志物通常会升高。检测急性心肌缺血的首选标志物是心肌肌钙蛋白I（cTnI）。然而，其预测冠状动脉搭桥手术后短期，尤其是中期预后的能力尚不确定。
230例未经选择接受手术血运重建的患者在术前及术后11次测量cTnI。使用术后cTnI峰值构建受试者工作特征曲线，以评估该检测的预后敏感性和特异性。13 ng/mL的临界值用于评估术后cTnI峰值释放对短期和中期预后的预后意义。
146例患者（63.5%）术后cTnI峰值小于13 ng/mL（平均峰值，6.6±3.1 ng/mL），84例患者（36.5%）术后cTnI峰值大于13 ng/mL（平均峰值，45.5±59.9 ng/mL）。cTnI峰值大于13 ng/mL的患者年龄较大，术前cTnI值较高。他们需要更长的阻断时间和体外循环时间。此外，cTnI大于13 ng/mL组的医院死亡率（9.5%对0.7%，p = 0.0009）显著更高。多变量分析显示，cTnI大于13 ng/mL是医院死亡（比值比10.33，p = 0.04）和心源性医院死亡的唯一独立预测因素。2年随访表明，术后cTnI释放对中期死亡率和因心脏病住院无影响。
心肌肌钙蛋白I是冠状动脉搭桥手术后即时心肌损伤的有价值标志物。其术后释放不能预测中期预后。
