Service d'Anesthésie Réanimation, Centre Hospitalier Privé Saint-Martin, 18 rue des Roquemonts, 14050 Caen Cedex 4, France.
Anesthesiology. 2009 Aug;111(2):250-7. doi: 10.1097/ALN.0b013e3181a1f720.
Simultaneous assessment of cardiac troponin I, B-type natriuretic peptide, and C-reactive protein has been found to provide unique prognostic information in acute coronary syndromes. The current study addressed the prognostic implication of a multiple-marker approach in cardiac surgery.
Two hundred twenty-four patients undergoing cardiac surgery were included and followed up within 12 months after surgery. Serial blood samples were drawn in all patients the day before surgery, at the end of surgery, and 6, 24, and 120 h after surgery. Major adverse cardiac events within 12 months after surgery were chosen as study endpoints and were defined as malignant ventricular arrhythmia, myocardial infarction, congestive heart failure, the need for myocardial revascularization, and/or death from cardiac cause. Predictive ability of each cardiac biomarker was assessed using logistic regression.
Accuracies of C-reactive protein, cardiac troponin I, and B-type natriuretic peptide, considered as continuous variables, to predict the occurrence of major adverse cardiac events were limited (area under receiver operating characteristic curve: 0.54 [0.47-0.60], P = 0.42; 0.62 [0.55-0.68], P = 0.01; and 0.68 [0.61-0.74], P < 0.001, respectively). When biomarkers were considered as 75% specificity dichotomized variables, elevated C-reactive protein (> 180 mg/l), cardiac troponin I (> 3.5 ng/ml), and B-type natriuretic peptide (> 880 pg/ml) were independent predictors of major adverse cardiac events (odds ratio: 2.14 [1.03-4.49], P = 0.043; 2.37 [1.25-5.64], P = 0.011; and 2.65 [1.16-4.85], P = 0.018, respectively) in a multivariate model including the European System for Cardiac Operative Risk Evaluation score.
Simultaneous measurement of cardiac troponin I, B-type natriuretic peptide, and C-reactive protein improves the risk assessment of long-term adverse cardiac outcome after cardiac surgery.
在急性冠状动脉综合征中，同时评估心肌肌钙蛋白 I、B 型利钠肽和 C 反应蛋白已被证明可提供独特的预后信息。本研究探讨了心脏手术后多标志物方法的预后意义。
纳入 224 例行心脏手术的患者，并在手术后 12 个月内进行随访。所有患者均在手术前一天、手术结束时以及手术后 6、24 和 120 小时抽取系列血样。术后 12 个月内发生的主要不良心脏事件被选为研究终点，定义为恶性室性心律失常、心肌梗死、充血性心力衰竭、需要再次血运重建以及/或心源性死亡。使用逻辑回归评估每个心脏生物标志物的预测能力。
将 C 反应蛋白、心肌肌钙蛋白 I 和 B 型利钠肽视为连续变量时，其预测主要不良心脏事件发生的准确性有限（受试者工作特征曲线下面积：0.54 [0.47-0.60]，P = 0.42；0.62 [0.55-0.68]，P = 0.01；和 0.68 [0.61-0.74]，P < 0.001）。当将生物标志物视为 75%特异性的二分变量时，升高的 C 反应蛋白（> 180 mg/l）、心肌肌钙蛋白 I（> 3.5 ng/ml）和 B 型利钠肽（> 880 pg/ml）是主要不良心脏事件的独立预测因素（比值比：2.14 [1.03-4.49]，P = 0.043；2.37 [1.25-5.64]，P = 0.011；和 2.65 [1.16-4.85]，P = 0.018，分别）在包括欧洲心脏手术风险评估系统评分的多变量模型中。
同时测量心肌肌钙蛋白 I、B 型利钠肽和 C 反应蛋白可提高心脏手术后长期不良心脏结局的风险评估。
