Department for Cardiovascular Surgery, Inselspital, Bern University Hospital University of Bern, Switzerland.
Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine, University of Toronto, Ontario, Canada.
J Am Heart Assoc. 2018 Feb 27;7(5):e007743. doi: 10.1161/JAHA.117.007743.
Cardiac troponin T (cTnT) is elevated after coronary artery bypass grafting surgery. The aim of this study was to determine the association between cTnT elevations between 6 and 12 hours after coronary artery bypass grafting and in-hospital outcome.
We prospectively studied 1722 patients undergoing isolated coronary artery bypass grafting. We assessed the association between conventional cTnT (749 patients) and high-sensitivity cTnT (hs-cTnT; 973 patients) 6 to 12 hours postoperatively with in-hospital major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, or stroke. The prespecified secondary outcome was a safety composite of MACCE, resuscitation, intensive care unit readmission or admission ≥48 hours, inotrope or vasopressor use ≥24 hours, or new-onset renal insufficiency. Among patients with a conventional cTnT measurement, 92 experienced a MACCE (12%) and 146 experienced a safety composite event (19%). Likewise, for hs-cTnT, 114 experienced a MACCE (12%) and 153 experienced a safety composite event (16%). Compared with cTnT ≤200 ng/L, each 200-ng/L increment in cTnT was associated with a monotonous increase in the odds of MACCE and the safety composite outcome. Conventional and hs-cTnT demonstrated moderate discrimination for MACCE (areas under the fitted receiver operating characteristics curve, 0.72 and 0.77 for conventional and hs-cTnT, respectively) and the safety composite outcome (areas under the fitted receiver operating characteristics curve, 0.66 and 0.74 for conventional and hs-cTnT, respectively) and resulted in improved prognostic performance when added to the EuroSCORE. At a cutoff of 800 ng/L, conventional and hs-cTnT provided clinically relevant power to rule in MACCE and the safety composite outcome.
cTnT levels assessed between 6 and 12 hours after coronary artery bypass grafting identify patients at increased risk of MACCE or other complications.
心脏肌钙蛋白 T（cTnT）在冠状动脉旁路移植手术后升高。本研究的目的是确定冠状动脉旁路移植手术后 6 至 12 小时 cTnT 升高与住院期间结局之间的关系。
我们前瞻性研究了 1722 例接受单纯冠状动脉旁路移植术的患者。我们评估了常规 cTnT（749 例患者）和高敏 cTnT（hs-cTnT；973 例患者）在术后 6 至 12 小时与住院期间主要不良心脏或脑血管事件（MACCE）的关系，MACCE 是全因死亡、心肌梗死或中风的复合终点。主要次要终点是 MACCE、复苏、入住重症监护病房≥48 小时、使用正性肌力药或血管加压药≥24 小时或新发肾功能不全的安全复合终点。在接受常规 cTnT 测量的患者中，92 例发生 MACCE（12%），146 例发生安全复合事件（19%）。同样，hs-cTnT 中，114 例发生 MACCE（12%），153 例发生安全复合事件（16%）。与 cTnT≤200ng/L 相比，cTnT 每增加 200ng/L，MACCE 和安全复合终点的发生几率均呈单调增加。常规和 hs-cTnT 对 MACCE（拟合的接受者操作特征曲线下面积分别为 0.72 和 0.77）和安全复合终点（拟合的接受者操作特征曲线下面积分别为 0.66 和 0.74）具有中等的区分能力，并且当加入 EuroSCORE 后，预测性能得到改善。在 800ng/L 的截点处，常规和 hs-cTnT 对 MACCE 和安全复合终点具有临床相关的排除能力。
冠状动脉旁路移植手术后 6 至 12 小时评估的 cTnT 水平可识别出发生 MACCE 或其他并发症风险增加的患者。
