Mauermann Eckhard, Bolliger Daniel, Fassl Jens, Grapow Martin, Seeberger Esther E, Seeberger Manfred D, Filipovic Miodrag, Lurati Buse Giovanna A L
Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
Ann Thorac Surg. 2017 Oct;104(4):1289-1297. doi: 10.1016/j.athoracsur.2017.03.003.
Elevated, single-measure, postoperative troponin is associated with adverse events after cardiac surgery. We hypothesized that increases in troponin from the first to the second postoperative day are also associated with all-cause, 12-month mortality and major adverse cardiac events (MACE).
This observational study included consecutive adults undergoing on-pump cardiac surgery with cardiac arrest. Troponin T was measured on the first and second postoperative day and was classified as "increasing" (>10%), "unchanged" (10% to -10%), or "decreasing" (<-10%). The primary endpoint was all-cause, 12-month mortality. Secondary endpoints were all-cause 12-month mortality or MACE and both outcomes at 30 days. The main analysis was by multivariable Cox regression.
Of 1,417 included patients, 99 (7.0%) died and 162 (11.4%) died or suffered MACE at 12 months. A significant interaction (p < 0.001) between first postoperative day troponin and the troponin trend from the first to the second postoperative day on 12-month, all-cause mortality precluded an analysis independent of first postoperative day troponin. Consequently, we stratified patients by their first postoperative day troponin (cutoff, 0.8 μg/L). Increasing troponin was associated with higher mortality in patients with first postoperative day troponin T ≥ 0.8 μg/L (hazard ratio, 1.98; 95% CI, 1.09 to 3.59; p = 0.025).
Troponin changes from the first to the second postoperative day should not be interpreted without consideration of the first postoperative day troponin concentration. For patients with a first postoperative day troponin ≥ 0.8 μg/L, an increase by more than 10% from the first to the second postoperative day was significantly associated with all-cause, 12-month mortality and other adverse events.
术后单次肌钙蛋白水平升高与心脏手术后的不良事件相关。我们推测术后第一天到第二天肌钙蛋白的升高也与全因12个月死亡率和主要不良心脏事件（MACE）相关。
这项观察性研究纳入了连续接受心脏停搏下体外循环心脏手术的成年人。在术后第一天和第二天测量肌钙蛋白T，并分为“升高”（>10%）、“不变”（-10%至10%）或“降低”（<-10%）。主要终点是全因12个月死亡率。次要终点是全因12个月死亡率或MACE以及30天时的这两个结局。主要分析采用多变量Cox回归。
在纳入的1417例患者中，99例（7.0%）死亡，162例（11.4%）在12个月时死亡或发生MACE。术后第一天肌钙蛋白与术后第一天到第二天肌钙蛋白变化趋势对12个月全因死亡率有显著交互作用（p<0.001），这使得无法进行独立于术后第一天肌钙蛋白的分析。因此，我们根据术后第一天肌钙蛋白（临界值，0.8μg/L）对患者进行分层。术后第一天肌钙蛋白T≥0.8μg/L的患者中，肌钙蛋白升高与更高的死亡率相关（风险比，1.98；95%CI，1.09至3.59；p=0.025）。
在不考虑术后第一天肌钙蛋白浓度的情况下，不应解读术后第一天到第二天肌钙蛋白的变化。对于术后第一天肌钙蛋白≥0.8μg/L的患者，术后第一天到第二天升高超过10%与全因12个月死亡率和其他不良事件显著相关。
