Department of Medicine, Division of Cardiology, Minneapolis VA Medical Center and University of Minnesota, Minneapolis, MN 55417, USA.
J Vasc Surg. 2013 Jan;57(1):166-72. doi: 10.1016/j.jvs.2012.06.084. Epub 2012 Sep 10.
The aim of this investigation was to determine if the presence of ischemic electrocardiographic (ECG) changes in patients undergoing vascular surgery provides incremental prognostic information about the long-term risk of death compared with a single peak troponin level within 48 hours after surgery.
This was a retrospective analysis of 337 patients undergoing moderate-risk to high-risk vascular surgery at our institution whose ECG and biomarker data were complete. Peak cardiac troponin (cTn) I values that exceeded the upper reference limit (URL) were categorized as low-positive (+), at or exceeding the URL but less than three times the URL, or high-positive (+), at or exceeding three times the URL. ECGs were classified as ischemic or nonischemic. The primary outcome was death at 1 year after the vascular operation. Independent predictors of long-term mortality were determined by Cox proportional hazards regression analysis.
The most common vascular problem was an expanding abdominal aortic aneurysm (n=185 [55%]). With regard to cTnI, 53 patients (16%) were classified as high (+) and 82 (24%) as low (+). The ECG in 21 patients (6%) showed evidence of myocardial ischemia. An increase in 1-year mortality of 3% for normal, 11% for low (+), and 17% for high (+) (P<.01) was seen with incremental cTn values. Independent predictors of long-term mortality were age (odds ratio [OR], 1.05, 95% confidence interval [CI], 1.02-1.07; P<.01), stratified troponin (OR, 1.62; 95% CI, 1.25-2.10; P<.01), tissue loss (OR, 3.30; 95% CI, 1.72-6.33; P<.01), stratified Revised Cardiac Risk Index (OR, 1.32; 95% CI, 0.97-1.81; P<.07), and statin use (OR, 0.62; 95% CI, 0.40-0.98; P=.04). The presence of ischemia on ECG was not a predictor of long-term mortality.
In the presence of an elevated cTn I, the ECG is not an independent predictor of long-term mortality after vascular surgery. These results support a strategy of routine surveillance of cTns after vascular surgery for the detection of cardiac events and postoperative risk stratification.
本研究旨在确定在接受血管手术的患者中，心电图（ECG）出现缺血性改变是否比术后 48 小时内单次肌钙蛋白峰值提供了关于长期死亡风险的额外预后信息，其风险高于单一肌钙蛋白峰值。
这是对在我院接受中高危血管手术的 337 例患者进行的回顾性分析，这些患者的心电图和生物标志物数据完整。超过上限参考值（URL）的峰值肌钙蛋白 I（cTn）I 值被分为低阳性（+），等于或超过 URL 但低于 URL 的三倍，或高阳性（+），等于或超过 URL 的三倍。ECG 分为缺血性或非缺血性。主要结局是血管手术后 1 年的死亡。通过 Cox 比例风险回归分析确定长期死亡率的独立预测因素。
最常见的血管问题是扩张性腹主动脉瘤（n=185 [55%]）。在 cTnI 方面，53 例（16%）患者被归类为高（+），82 例（24%）患者被归类为低（+）。21 例（6%）患者的心电图显示有心肌缺血证据。正常、低（+）和高（+）的 1 年死亡率分别增加 3%、11%和 17%（P<.01），cTn 值逐渐增加。长期死亡率的独立预测因素是年龄（优势比[OR]，1.05，95%置信区间[CI]，1.02-1.07；P<.01）、分层肌钙蛋白（OR，1.62；95%CI，1.25-2.10；P<.01）、组织丢失（OR，3.30；95%CI，1.72-6.33；P<.01）、分层修订后的心脏风险指数（OR，1.32；95%CI，0.97-1.81；P<.07）和他汀类药物的使用（OR，0.62；95%CI，0.40-0.98；P=.04）。心电图出现缺血并不是长期死亡率的预测因素。
在 cTn I 升高的情况下，ECG 并不是血管手术后长期死亡率的独立预测因素。这些结果支持在血管手术后常规监测 cTn 以检测心脏事件和术后风险分层的策略。
