Gorgun Emre, Lan Billy Y, Aydinli H Hande, Reed Grant W, Menon Venu, Sessler Daniel I, Stocchi Luca, Remzi Feza H
*Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH †Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH ‡Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
Ann Surg. 2016 Oct;264(4):605-11. doi: 10.1097/SLA.0000000000001854.
The aim of this study is to identify the association between early postoperative troponin elevations and outcomes after major colorectal surgery.
Myocardial infarction is the leading cause of death after noncardiac surgery. Most postoperative myocardial infarctions are clinically silent, and asymptomatic troponin elevations have the same early mortality as symptomatic infarctions.
Patients over the age of 45, undergoing major colorectal surgery from March 2015 to January 2016, were identified. Plasma troponin T concentrations were prospectively collected within 24 and 48 hours after surgery. Characteristics, evaluations, management, and outcomes of patients with elevated troponin concentrations were analyzed. Mortality within the follow-up period was the primary end point.
A total of 1020 patients were screened with postoperative troponin concentrations. Fifty patients had troponin concentrations >0.01 ng/mL. Patients rarely (16%) had ischemic symptoms. Cardiology was consulted for 23 patients and started on medical therapy. Seventeen of these patients were alive at follow-up. Ten patients (20%) with troponin concentrations >0.01 ng/mL died within the follow-up period, 7 of which had concentrations ≥0.03 ng/mL.
Most postoperative myocardial injury is asymptomatic and may only be detected by routine troponin screening. Elevated troponin concentrations after colorectal surgery may facilitate identifying patients at postoperative risk and prompt appropriate testing. Early intervention in select patients may lead to potential reduction of mortality after major colorectal surgery.
本研究旨在确定结直肠大手术后早期肌钙蛋白升高与术后结局之间的关联。
心肌梗死是非心脏手术后的主要死亡原因。大多数术后心肌梗死在临床上无症状，无症状的肌钙蛋白升高与有症状的梗死具有相同的早期死亡率。
纳入2015年3月至2016年1月期间接受结直肠大手术的45岁以上患者。前瞻性收集术后24小时和48小时内的血浆肌钙蛋白T浓度。分析肌钙蛋白浓度升高患者的特征、评估、管理及结局。随访期内的死亡率为主要终点。
共对1020例患者进行了术后肌钙蛋白浓度筛查。50例患者的肌钙蛋白浓度>0.01 ng/mL。患者很少出现（16%）缺血症状。23例患者咨询了心脏病科并开始药物治疗。其中17例患者在随访时存活。10例（20%）肌钙蛋白浓度>0.01 ng/mL的患者在随访期内死亡，其中7例浓度≥0.03 ng/mL。
大多数术后心肌损伤无症状，可能仅通过常规肌钙蛋白筛查才能发现。结直肠手术后肌钙蛋白浓度升高可能有助于识别术后有风险的患者并促使进行适当检查。对部分患者进行早期干预可能会降低结直肠大手术后的死亡率。
