Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Essen, Germany.
Eur J Cardiothorac Surg. 2012 Dec;42(6):951-7. doi: 10.1093/ejcts/ezs122. Epub 2012 Apr 4.
Cardiac troponin I (cTnI) is a highly sensitive, specific marker for myocardial cell injury. We sought to determine whether cTnI on admission may help to identify patients with increased risk of open surgical embolectomy with acute pulmonary embolism (PE).
Forty-six consecutive patients with confirmed acute PE were enrolled in this prospective study. PE was confirmed by pulmonary angiography, computed tomography (CT) scan or echocardiography. Severity of PE was assessed by clinical data, and cTnI was measured within 12 h after admission.
cTnI was elevated in 28 patients with acute PE. Preoperative right ventricular dysfunction [odds ratio (OR): 15.2; 95% confidence interval (CI): 2.02-144.8; P < 0.002], prolonged hypotension with cardiogenic shock (OR: 14.9; 95% CI: 2.2-131.1; P < 0.002) and preoperative need for resuscitation (OR: 6.0; 95% CI: 0.6-143.8; P = 0.12) were more prevalent in patients with elevated cTnI serum concentrations. cTnI-positive patients were also more likely to require inotropic support (OR: 10.0; 95% CI: 1.8-65.1; P < 0.005) and mechanical ventilation (OR: 13.5; 95% CI: 2.2-95.6; P < 0.005). Moreover, an elevated cTnI level on admission significantly correlated with both primary endpoints, in-hospital mortality (OR: 9.0; 95% CI: 1.0-215.2; P = 0.03) and major adverse clinical events (OR: 8.3; 95% CI: 1.5-62.5; P = 0.006). After multivariable risk adjustment, a positive cTnI value remained an independent predictor of in-hospital mortality (OR: 13.6; 95% CI: 3.22-145.8; P = 0.014) and major adverse clinical events (OR: 15.7; 95% CI: 4.15-133.7; P = 0.031).
cTnI on admission may improve risk assessment of patients undergoing open surgical embolectomy due to acute PE.
心肌肌钙蛋白 I（cTnI）是一种高度敏感、特异的心肌细胞损伤标志物。我们旨在确定入院时 cTnI 是否有助于识别急性肺栓塞（PE）行开放性外科取栓术风险增加的患者。
本前瞻性研究纳入了 46 例确诊为急性 PE 的连续患者。通过肺动脉造影、计算机断层扫描（CT）或超声心动图确认 PE。根据临床资料评估 PE 严重程度，并在入院后 12 小时内测量 cTnI。
28 例急性 PE 患者 cTnI 升高。术前右心室功能障碍（比值比 [OR]：15.2；95%置信区间 [CI]：2.02-144.8；P < 0.002）、心源性休克时低血压时间延长（OR：14.9；95% CI：2.2-131.1；P < 0.002）和术前需要复苏（OR：6.0；95% CI：0.6-143.8；P = 0.12）在 cTnI 血清浓度升高的患者中更为常见。cTnI 阳性患者也更可能需要正性肌力支持（OR：10.0；95% CI：1.8-65.1；P < 0.005）和机械通气（OR：13.5；95% CI：2.2-95.6；P < 0.005）。此外，入院时 cTnI 水平升高与主要终点（院内死亡率 [OR]：9.0；95% CI：1.0-215.2；P = 0.03）和主要不良临床事件（OR：8.3；95% CI：1.5-62.5；P = 0.006）显著相关。多变量风险调整后，cTnI 阳性仍是院内死亡率（OR：13.6；95% CI：3.22-145.8；P = 0.014）和主要不良临床事件（OR：15.7；95% CI：4.15-133.7；P = 0.031）的独立预测因素。
入院时 cTnI 可提高因急性 PE 而行开放性外科取栓术患者的风险评估。
