Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Anesthesiology. 2011 Apr;114(4):796-806. doi: 10.1097/ALN.0b013e31820ad503.
There is uncertainty regarding the prognostic value of troponin and creatine kinase muscle and brain isoenzyme measurements after noncardiac surgery.
The current study undertook a systematic review and meta-analysis. The study used six search strategies and included noncardiac surgery studies that provided data from a multivariable analysis assessing whether a postoperative troponin or creatine kinase muscle and brain isoenzyme measurement was an independent predictor of mortality or a major cardiovascular event. Independent investigators determined study eligibility and abstracted data in duplicate.
Fourteen studies, enrolling 3,318 patients and 459 deaths, demonstrated that an increased troponin measurement after surgery was an independent predictor of mortality (odds ratio [OR] 3.4, 95% confidence interval [CI] 2.2-5.2), but there was substantial heterogeneity (I(2) = 56%). The independent prognostic capabilities of an increased troponin value after surgery in the 10 studies that assessed intermediate-term (≤ 12 months) mortality was an OR = 6.7 (95% CI 4.1-10.9, I(2) = 0%) and in the 4 studies that assessed long-term (more than 12 months) mortality was an OR = 1.8 (95% CI 1.4-2.3, I(2) = 0%; P < 0.001 for test of interaction). Four studies, including 1,165 patients and 202 deaths, demonstrated an independent association between an increased creatine kinase muscle and brain isoenzyme measurement after surgery and mortality (OR 2.5, 95% CI 1.5-4.0, I(2) = 4%).
An increased troponin measurement after surgery is an independent predictor of mortality, particularly within the first year; limited data suggest an increased creatine kinase muscle and brain isoenzyme measurement also predicts subsequent mortality. Monitoring troponin measurements after noncardiac surgery may allow physicians to better risk stratify and manage their patients.
非心脏手术后肌钙蛋白和肌酸激酶脑型同工酶测量的预后价值存在不确定性。
本研究进行了系统评价和荟萃分析。该研究采用了六种搜索策略，纳入了提供多变量分析数据的非心脏手术研究，评估术后肌钙蛋白或肌酸激酶脑型同工酶测量是否为死亡率或主要心血管事件的独立预测因素。独立调查人员确定了研究的纳入标准，并对数据进行了重复提取。
四项研究共纳入 3318 名患者和 459 例死亡，结果表明术后肌钙蛋白升高是死亡率的独立预测因素（比值比 [OR] 3.4，95%置信区间 [CI] 2.2-5.2），但存在很大的异质性（I²=56%）。在评估 10 项中期（≤12 个月）死亡率的研究中，手术后肌钙蛋白升高的独立预后能力为 OR=6.7（95% CI 4.1-10.9，I²=0%），在评估 4 项长期（超过 12 个月）死亡率的研究中为 OR=1.8（95% CI 1.4-2.3，I²=0%；P<0.001 用于检验交互作用）。四项研究共纳入 1165 名患者和 202 例死亡，表明手术后肌酸激酶脑型同工酶升高与死亡率之间存在独立关联（OR 2.5，95% CI 1.5-4.0，I²=4%）。
手术后肌钙蛋白升高是死亡率的独立预测因素，特别是在术后的第一年；有限的数据表明肌酸激酶脑型同工酶升高也预示着随后的死亡率。监测非心脏手术后的肌钙蛋白测量可能使医生能够更好地对患者进行风险分层和管理。
