Mohler Emile R, Mantha Srinivas, Miller Alan B, Poldermans Don, Cropp Anne B, St Aubin Lisa B, Billing Clare B, Fleisher Lee A
University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Vasc Med. 2007 Aug;12(3):175-81. doi: 10.1177/1358863X07081139.
The current guidelines for the evaluation and prediction of adverse cardiovascular events (CVEs) following vascular surgery in high-risk patients recommends serial electrocardiograms (ECGs) but not biomarkers such as cTn-I and CK-MB. The objective of this study was to determine whether biomarkers should be routinely measured in high-risk patients undergoing vascular surgery. A multicenter, prospective study with investigators blinded to core laboratory results was conducted. cTn-I and CK-MB were obtained on the day of surgery, as well as 24 hours, 72 hours and 120 hours after surgery, 24 hours prior to planned hospital discharge and at the onset of symptoms of a suspected CVE. The CVE was adjudicated by an endpoint committee using ECG, biomarker and symptoms data and was defined as cardiac death or myocardial infarction (MI) occurring up to 30 days after surgery. A total of 784 patients, with a mean age of 70.1 (SD +/- 9.8), underwent vascular surgery. Of the 83 patients with a CVE, cTn-I was positive in 42 and CK-MB was positive in 29 on or before the day of the CVE. The number of patients not classified as having a CVE but positive for elevation of cTn-I or CK-MB was 64 and 20, respectively. cTn-I was more sensitive than CK-MB (50.6% versus 34.9%) for predicting a CVE. The optimum time for measuring cTn-I after surgery with the highest positive predictive value was 24 hours. In conclusion, these data support routine serial measurement of cTn-I after vascular surgery.
目前针对高危患者血管手术后不良心血管事件（CVE）评估和预测的指南推荐进行系列心电图（ECG）检查，但不包括生物标志物如肌钙蛋白I（cTn-I）和肌酸激酶同工酶（CK-MB）。本研究的目的是确定在接受血管手术的高危患者中是否应常规检测生物标志物。开展了一项多中心前瞻性研究，研究人员对核心实验室结果不知情。在手术当天、术后24小时、72小时和120小时、计划出院前24小时以及疑似CVE症状出现时获取cTn-I和CK-MB。由一个终点委员会根据ECG、生物标志物和症状数据判定CVE，其定义为术后30天内发生的心源性死亡或心肌梗死（MI）。共有784例患者接受了血管手术，平均年龄为70.1岁（标准差±9.8）。在83例发生CVE的患者中，42例在CVE当天或之前cTn-I呈阳性，29例CK-MB呈阳性。未被归类为发生CVE但cTn-I或CK-MB升高呈阳性的患者分别为64例和20例。cTn-I在预测CVE方面比CK-MB更敏感（50.6%对34.9%）。术后测量cTn-I具有最高阳性预测价值的最佳时间是24小时。总之，这些数据支持血管手术后常规系列检测cTn-I。
