Division of Cardiology, Hennepin County Medical Center, Minneapolis, MN 55155, USA.
Am J Nephrol. 2012;35(2):175-80. doi: 10.1159/000335679. Epub 2012 Jan 25.
The relationship of routine postoperative troponin I (TnI) monitoring in kidney transplant recipients and in-hospital myocardial infarction (MI) is not known.
This observational study evaluated the prevalence of abnormal postoperative TnI (Ortho Clinical Diagnostics assay) in 376 consecutive kidney or kidney/pancreas transplant recipients. In-hospital MI was adjudicated using the universal definition. Rates of death and coronary revascularizations at 1 year were studied. Logistic regression analysis was performed to identify independent predictors of abnormal TnI.
Ninety-five (25%) recipients had abnormal TnI (>0.04 ng/ml) following transplantation. Abnormal TnI levels were more common in older (mean age: 52.2 ± 13.4 vs. 48.3 ± 13.2 years, p = 0.01), diabetic (57.9 vs. 45.6%, p = 0.04), and prior coronary artery disease (31.6 vs. 20.3%, p = 0.02) patients. In-hospital MI occurred in 6 patients (1.6%). All subsequent in-hospital cardiovascular events occurred in the abnormal postoperative TnI group; most in those with TnI levels >1 ng/ml. Previous coronary artery disease was the only independent predictor of a postoperative TnI level >1 ng/ml in multivariate analysis (odds ratio 4.61, 95% confidence interval 1.49-14.32). At 1 year there was no significant difference in death (3.2 vs. 1.8%, p = 0.42) and borderline significant difference in coronary revascularization (5.3 vs. 1.4%, p = 0.049) in abnormal versus normal TnI groups.
In-hospital MI was infrequent, but abnormal TnI highly prevalent following renal transplantation. Normal TnI levels following renal transplantation had a high negative predictive value in excluding patients likely to develop subsequent postoperative MI. The role of a higher TnI cut-off for screening for postoperative MI in high-risk subgroups deserves future prospective evaluation.
肾移植受者术后常规肌钙蛋白 I（TnI）监测与院内心肌梗死（MI）的关系尚不清楚。
本观察性研究评估了 376 例连续肾或肾/胰腺移植受者术后异常 TnI（Ortho Clinical Diagnostics 测定法）的发生率。采用通用定义确定院内 MI。研究了 1 年时的死亡率和冠状动脉血运重建率。采用 logistic 回归分析确定异常 TnI 的独立预测因子。
95 例（25%）受者移植后 TnI 异常（>0.04ng/ml）。TnI 水平异常者年龄较大（平均年龄：52.2±13.4 岁比 48.3±13.2 岁，p=0.01）、糖尿病（57.9%比 45.6%，p=0.04）和既往冠心病（31.6%比 20.3%，p=0.02）更为常见。6 例（1.6%）患者发生院内 MI。所有随后的院内心血管事件均发生在术后 TnI 异常组；大多数 TnI 水平>1ng/ml 者。多变量分析显示，既往冠心病是术后 TnI 水平>1ng/ml 的唯一独立预测因子（比值比 4.61，95%置信区间 1.49-14.32）。1 年时，TnI 异常组与 TnI 正常组在死亡率方面无显著差异（3.2%比 1.8%，p=0.42），在冠状动脉血运重建方面有边缘显著差异（5.3%比 1.4%，p=0.049）。
肾移植后院内 MI 虽不常见，但 TnI 异常发生率高。肾移植后 TnI 正常对排除可能发生术后 MI 的患者具有很高的阴性预测价值。对于高危亚组，更高 TnI 截断值筛查术后 MI 的作用值得进一步前瞻性评估。
