冠状动脉旁路移植术后高敏肌钙蛋白T的早期预后价值

Early Prognostic Value of High-Sensitivity Troponin T after Coronary Artery Bypass Grafting.

作者信息

Machado Mauricio Nassau, Rodrigues Fernando Bruetto, Grigolo Ingrid Hellen, Sabbag Amália Tieco Rocha, Silva Osvaldo Lourenço, Maia Lilia Nigro, Nakazone Marcelo Arruda

机构信息

Cardiac Surgery Intensive Care Unit, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, Brazil.

Coronary Care Unit, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, Brazil.

出版信息

Thorac Cardiovasc Surg. 2019 Sep;67(6):467-474. doi: 10.1055/s-0038-1675640. Epub 2018 Nov 28.

DOI:10.1055/s-0038-1675640

PMID:30485894

Abstract

BACKGROUND

Periprocedural myocardial injury after coronary artery bypass grafting (CABG) may affect the patient's prognosis and may be due to a different set of factors beyond the atherosclerotic plaque instability. Considering the challenges in the diagnosis of myocardial injury after CABG, the aim of this study was to determine the association between postoperative early elevation of high-sensitivity troponin T (hsTnT) and all-cause 30-day mortality after CABG.

METHODS

We enrolled 600 consecutive patients who underwent CABG. The hsTnT value was measured immediately before surgery and in the morning of the first postoperative day.

RESULTS

The baseline hsTnT was 13 ng/L (7-26 ng/L) and 273 patients (45.7%) had baseline hsTnT above the 99th percentile/upper reference limit (URL) (14 ng/L). The median for hsTnT at first postoperative day was 235 ng/L (152-425 ng/L). We calculated the postoperative hsTnT ratio to URL for each patient, representing the number of times exceeding the URL (hsTnT value divided by 14 ng/L). The multivariate analysis by Cox proportional hazard model revealed that age (years) (hazard ratio [HR] = 1.13, 95% confidence interval [CI]: 1.07-1.20; < 0.001) and postoperative hsTnT ratio to URL (per 10-fold increase) (HR = 1.06, 95% CI: 1.04-1.08; < 0.001) were independent predictors of all-cause 30-day mortality after CABG.

CONCLUSION

In our series, age and higher postoperative hsTnT levels were independent and reliable predictors of all-cause 30-day mortality after CABG.

摘要

背景

冠状动脉旁路移植术（CABG）围手术期心肌损伤可能影响患者预后，且可能由动脉粥样硬化斑块不稳定之外的一系列不同因素导致。考虑到CABG术后心肌损伤诊断方面的挑战，本研究旨在确定高敏肌钙蛋白T（hsTnT）术后早期升高与CABG术后30天全因死亡率之间的关联。

方法

我们纳入了600例连续接受CABG的患者。在手术前即刻及术后第一天早晨测量hsTnT值。

结果

基线hsTnT为13 ng/L（7 - 26 ng/L），273例患者（45.7%）的基线hsTnT高于第99百分位数/参考上限（URL）（14 ng/L）。术后第一天hsTnT的中位数为235 ng/L（152 - 425 ng/L）。我们计算了每位患者术后hsTnT与URL的比值，即超过URL的倍数（hsTnT值除以14 ng/L）。Cox比例风险模型的多因素分析显示，年龄（岁）（风险比[HR] = 1.13，95%置信区间[CI]：1.07 - 1.20；P < 0.001）和术后hsTnT与URL的比值（每增加10倍）（HR = 1.06，95% CI：1.04 - 1.08；P < 0.001）是CABG术后30天全因死亡率的独立预测因素。