Onorati Francesco, Cristodoro Lucia, Caroleo Santo, Esposito Antonio, Amantea Bruno, Santangelo Ermenegildo, Renzulli Attilio
Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy.
Ann Thorac Surg. 2007 Mar;83(3):1016-23. doi: 10.1016/j.athoracsur.2006.10.103.
Postoperative troponin I and lactate elevation are related to cardiac complications after myocardial revascularization. We sought to evaluate earlier predictive value for acute myocardial infarction (AMI) and myocardial damage of troponin I and lactate after myocardial revascularization.
In all, 183 consecutive isolated myocardial revascularizations were prospectively enrolled in the study. Troponin I and lactate were sampled preoperatively and intraoperatively from the coronary sinus, and at 12, 24, 48, and 72 hours. Hospital outcome was recorded. Receiver operating curves for coronary sinus troponin I and lactate were constructed to differentiate patients with or without AMI and myocardial damage.
Acute myocardial infarction developed in 6 patients (3.2%), with higher troponin I and lactate at all time points (p < 0.05), longer intubation time (p = 0.003), intensive care unit stay (p = 0.001), hospital stay (p = 0.001), higher atrial fibrillation (p = 0.001), and worse ventricular function (p = 0.001). Myocardial damage developed in 6 patients (3.2%), showing higher troponin I at all time points (p < 0.001), higher intraoperative lactate (p = 0.04), longer intubation time (p = 0.005), and intensive care unit stay (p = 0.03). Receiver operating characteristic curves demonstrated coronary sinus troponin I greater than 0.94 microg/L (area under the curve [AUC] 0.820 +/- 0.075; sensitivity 90.0%, specificity 68.9%) as a better discriminator between patients with or without AMI than lactate level greater than 2.85 mmol/L (AUC 0.686 +/- 0.090; sensitivity 80.0%; specificity 72.9%); troponin I greater than 0.65 microg/L was a better discriminator between patients with or without myocardial damage (AUC 0.834 +/- 0.061; sensitivity 93.8%, specificity 71.5%), than lactate greater than 2.05 mmol/L (AUC 0.627 +/- 0.067; sensitivity 87.5%; specificity 70.7%).
Coronary sinus troponin I and lactate are predictive for cardiac complications after myocardial revascularization. Intraoperative biochemical assays should be routinely performed to establish preventative strategies to reduce further myocardial damage.
术后肌钙蛋白I和乳酸升高与心肌血运重建术后的心脏并发症相关。我们试图评估心肌血运重建术后肌钙蛋白I和乳酸对急性心肌梗死（AMI）和心肌损伤的早期预测价值。
本研究前瞻性纳入了连续183例孤立性心肌血运重建术患者。术前和术中从冠状窦采集肌钙蛋白I和乳酸样本，并在术后12、24、48和72小时采集。记录住院结局。构建冠状窦肌钙蛋白I和乳酸的受试者工作曲线，以区分有无AMI和心肌损伤的患者。
6例患者（3.2%）发生急性心肌梗死，所有时间点的肌钙蛋白I和乳酸水平均较高（p<0.05），插管时间更长（p = 0.003），重症监护病房停留时间更长（p = 0.001），住院时间更长（p = 0.001），房颤发生率更高（p = 0.001），心室功能更差（p = 0.001）。6例患者（3.2%）发生心肌损伤，所有时间点的肌钙蛋白I水平均较高（p<0.001），术中乳酸水平较高（p = 0.04），插管时间更长（p = 0.005），重症监护病房停留时间更长（p = 0.03）。受试者工作特征曲线显示，冠状窦肌钙蛋白I大于0.94μg/L（曲线下面积[AUC]0.820±0.075；敏感性90.0%，特异性68.9%）比乳酸水平大于2.85mmol/L（AUC 0.686±0.090；敏感性80.0%；特异性72.9%）更能区分有无AMI的患者；肌钙蛋白I大于0.65μg/L比乳酸大于2.05mmol/L（AUC 0.627±0.067；敏感性87.5%；特异性70.7%）更能区分有无心肌损伤的患者（AUC 0.834±0.061；敏感性93.8%，特异性71.5%）。
冠状窦肌钙蛋白I和乳酸可预测心肌血运重建术后的心脏并发症。应常规进行术中生化检测，以制定预防策略，减少进一步的心肌损伤。
