Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege and Roskilde, Denmark
Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege and Roskilde, Denmark.
Br J Anaesth. 2016 Nov;117(5):559-568. doi: 10.1093/bja/aew321.
Patients undergoing non-cardiac, non-vascular surgery are at risk of major cardiovascular complications. In non-cardiac surgery, troponin elevation has previously been shown to be an independent predictor of major adverse cardiac events and postoperative mortality; however, a majority of studies have focused on vascular surgery patients. The aim of this meta-analysis was to determine whether troponin elevation is a predictor of major adverse cardiac events and mortality within 30 days and 1 yr after non-cardiac, non-vascular surgery.
A systematic review and meta-analysis was conducted in January 2016 according to the Meta-analysis Of Observational Studies in Epidemiology guidelines. Both interventional and observational studies measuring troponin within the first 4 days after surgery were eligible. A systematic search was performed in PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials.
Eleven eligible clinical studies (n=2193) were identified. A postoperative troponin elevation was a predictor of 30 day mortality, odds ratio (OR) 3.52 [95% confidence interval (CI) 2.21-5.62; I=0%], and an independent predictor of 1 yr mortality, adjusted OR 2.53 (95% CI 1.20-5.36; I=26%). A postoperative troponin elevation was associated with major adverse cardiac events at 30 days, OR 5.92 (95% CI 1.67-20.96; I=86%), and 1 yr after surgery, adjusted OR 3.00 (95% CI 1.43-6.29; I=21%).
Postoperative myocardial injury is an independent predictor of major adverse cardiac events and mortality within 30 days and 1 yr after non-cardiac, non-vascular surgery. The meta-analysis provides evidence that supports troponin monitoring as a cardiovascular risk stratification tool.
接受非心脏、非血管手术的患者存在发生重大心血管并发症的风险。在非心脏手术中，肌钙蛋白升高以前被证明是重大不良心脏事件和术后死亡的独立预测因素；然而，大多数研究都集中在血管手术患者上。本荟萃分析的目的是确定肌钙蛋白升高是否可预测非心脏、非血管手术后 30 天和 1 年内发生重大不良心脏事件和死亡。
根据《观察性研究的荟萃分析流行病学指南》，于 2016 年 1 月进行了系统评价和荟萃分析。符合条件的研究是指在手术后 4 天内测量肌钙蛋白的干预性和观察性研究。在 PubMed、EMBASE、Scopus 和 Cochrane 对照试验中心注册库中进行了系统检索。
确定了 11 项符合条件的临床研究（n=2193）。术后肌钙蛋白升高是 30 天死亡率的预测因素，比值比（OR）为 3.52（95%置信区间[CI]为 2.21-5.62；I=0%），也是 1 年死亡率的独立预测因素，调整后的 OR 为 2.53（95%CI 为 1.20-5.36；I=26%）。术后肌钙蛋白升高与 30 天内的重大不良心脏事件相关，OR 为 5.92（95%CI 为 1.67-20.96；I=86%），以及手术后 1 年，调整后的 OR 为 3.00（95%CI 为 1.43-6.29；I=21%）。
术后心肌损伤是非心脏、非血管手术后 30 天和 1 年内发生重大不良心脏事件和死亡的独立预测因素。荟萃分析提供的证据支持肌钙蛋白监测作为心血管风险分层工具。
