Department of Medicine, Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Medicine, Dongtan Sacred Heart Hospital, Hwasung, Hallym University School of Medicine, Republic of Korea.
PLoS One. 2019 Jun 27;14(6):e0219043. doi: 10.1371/journal.pone.0219043. eCollection 2019.
Whether high-sensitivity cardiac troponin elevation during the perioperative period is associated with poor clinical outcome in revascularized coronary patients who undergo noncardiac surgery remains unclear. We investigated the effects of perioperative troponin elevation on the long-term clinical outcomes of patients with a history of coronary revascularization.
We analyzed patients whose pre- or postoperative high-sensitivity cardiac troponin I (hs-cTnI) assay results were available. Patients were divided into two groups according to hs-cTnI levels. The patient groups were analyzed separately according to whether hs-cTnI was assessed preoperatively or postoperatively. The primary outcome was all-cause death during the follow-up period.
Median follow-up duration was 25 months (interquartile range 11-50). In the propensity-matched analysis, the risk of all-cause death during follow-up was higher in the group with elevated hs-cTnI group than in the normal group (12.7% vs 6.3%; hazard ratio [HR], 2.67; 95% confidential interval [CI], 1.04-6.82; p = 0.04). In the propensity-matched analysis of preoperative hs-cTnI levels, we found no significant difference between the groups in the rate of all-cause death (12.9% vs. 11.9%; HR, 1.06; 95% CI, 0.45-2.50; p = 0.89). In the postoperative propensity-matched analysis, all-cause death was higher in patients with elevated hs-cTnI than in those with normal levels (14.9% vs. 5.9%; HR, 2.80; 95% CI, 1.01-7.77; p = 0.048).
In revascularized coronary patients who underwent noncardiac surgery, postoperative (but not preoperative) hs-cTnI elevation was associated with all-cause death during follow-up. Larger datasets are needed to support this finding.
在接受非心脏手术的经血管重建的冠心病患者中，围术期高敏肌钙蛋白升高是否与不良临床结局相关尚不清楚。我们研究了围术期肌钙蛋白升高对有冠状动脉血运重建史患者长期临床结局的影响。
我们分析了术前或术后高敏肌钙蛋白 I（hs-cTnI）检测结果可用的患者。根据 hs-cTnI 水平将患者分为两组。根据 hs-cTnI 是术前评估还是术后评估，分别对患者组进行分析。主要结局是随访期间的全因死亡。
中位随访时间为 25 个月（四分位距 11-50）。在倾向评分匹配分析中，与 hs-cTnI 正常组相比，hs-cTnI 升高组在随访期间全因死亡的风险更高（12.7%比 6.3%；风险比[HR]，2.67；95%置信区间[CI]，1.04-6.82；p=0.04）。在术前 hs-cTnI 水平的倾向评分匹配分析中，两组全因死亡率无显著差异（12.9%比 11.9%；HR，1.06；95%CI，0.45-2.50；p=0.89）。在术后倾向评分匹配分析中，hs-cTnI 升高组的全因死亡率高于 hs-cTnI 正常组（14.9%比 5.9%；HR，2.80；95%CI，1.01-7.77；p=0.048）。
在接受非心脏手术的经血管重建的冠心病患者中，术后（而非术前）hs-cTnI 升高与随访期间的全因死亡相关。需要更大的数据集来支持这一发现。
