Department of Anaesthesia, Erasmus University Medical Center, Rotterdam, the Netherlands.
Int J Cardiol. 2019 Apr 1;280:8-13. doi: 10.1016/j.ijcard.2019.01.035. Epub 2019 Jan 10.
Troponin elevations after intermediate-to-high risk noncardiac surgery are common and can predict mortality. However, the prognostic value for early and late major adverse cardiovascular events (MACE) is less well investigated. The authors evaluated the relationship between postoperative troponin release and MACE in the first year after noncardiac surgery.
This observational cohort registry comprised data of patients aged ≥60 years undergoing intermediate-to-high risk noncardiac surgery between July 2012 and 2015, at the Erasmus University Medical Center, Rotterdam, the Netherlands. High-sensitivity troponin T was measured on day 1 to 3 after surgery. Peak troponin values were divided into four categories: <14 ng·L, 14-49 ng·L, 50-149 ng·L and ≥150 ng·L. The primary endpoint MACE was defined as the occurrence of myocardial infarction, angina, revascularization therapy or cerebrovascular accident in the first year after surgery. The incidence of MACE and all-cause mortality was calculated using Kaplan-Meier estimates. Cox regression was used to estimate risks for both endpoints.
In total, 3085 patients were included for analyses and peak troponin elevation above 14 ng·L was present in 1678 (54.4%) patients. The overall incidence for one-year MACE was 5.8% (3.4%, 6.1%, 10.4% and 40.6% per increasing troponin category) with adjusted HR (95% CI) 1.32 (0.85-2.06), 2.53 (1.42-4.53) and 10.24 (5.91-17.75) for the consecutive increasing categories. One-year mortality occurred in 14.6% and showed a similar stepwise increase with adjusted HR (95% CI) 1.25 (0.98-1.60), 2.39 (1.72-3.32) and 3.79 (2.60-5.54).
Our dataset demonstrates a graded relationship between postoperative troponin release and occurrence of MACE in the first year after intermediate-to-high risk noncardiac surgery.
中高危非心脏手术后肌钙蛋白升高很常见，可预测死亡率。然而，术后肌钙蛋白释放与早期和晚期主要不良心血管事件（MACE）之间的预后价值研究较少。作者评估了非心脏手术后第一年术后肌钙蛋白释放与 MACE 之间的关系。
本观察性队列登记研究纳入了 2012 年 7 月至 2015 年在荷兰鹿特丹伊拉斯姆斯大学医学中心接受中高危非心脏手术的年龄≥60 岁患者的数据。术后第 1 至 3 天检测高敏肌钙蛋白 T。根据术后肌钙蛋白峰值将患者分为 4 组：<14ng·L、14-49ng·L、50-149ng·L 和≥150ng·L。主要终点 MACE 定义为术后 1 年内发生心肌梗死、心绞痛、血运重建治疗或脑血管意外。使用 Kaplan-Meier 估计计算 MACE 和全因死亡率的发生率。Cox 回归用于估计两个终点的风险。
共纳入 3085 例患者进行分析，1678 例（54.4%）患者出现肌钙蛋白峰值升高>14ng·L。1 年 MACE 的总发生率为 5.8%（3.4%、6.1%、10.4%和 40.6%，递增肌钙蛋白分类），调整后的 HR（95%CI）分别为 1.32（0.85-2.06）、2.53（1.42-4.53）和 10.24（5.91-17.75）。1 年死亡率为 14.6%，调整后的 HR（95%CI）也呈逐渐升高趋势，分别为 1.25（0.98-1.60）、2.39（1.72-3.32）和 3.79（2.60-5.54）。
我们的数据表明，中高危非心脏手术后第一年术后肌钙蛋白释放与 MACE 的发生呈分级关系。
