Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St. Olavs University Hospital, Trondheim, Norway.
J Cardiothorac Vasc Anesth. 2019 Dec;33(12):3309-3319. doi: 10.1053/j.jvca.2019.06.029. Epub 2019 Jun 23.
Investigate important clinical and operative variables associated with increases in cardiac troponin T (cTnT) as indicators of myocardial injury after coronary artery bypass grafting (CABG).
Prospective cohort study.
Single university hospital.
The study comprised 626 patients undergoing isolated CABG from April 2008 through April 2010 with a validation cohort (n = 686) from 2015-2017.
None.
Perioperative variables were registered prospectively. The extent of diffuse coronary atherosclerosis and significant stenoses were assessed with preoperative coronary angiography. Mixed model analysis was used to construct a statistical model explaining the course of cTnT concentrations. The model was adjusted for preoperative and intraoperative/postoperative myocardial infarction (MI) for independent assessment of additional variables. Clinical factors associated with increased cTnT concentrations during and after CABG were longer duration of cardiopulmonary bypass (p < 0.001), higher preoperative creatinine (p < 0.001), New York Heart Association functional classification IV (p = 0.006), reduced LVEF (p = 0.034), higher preoperative C-reactive protein (p = 0.049), and intraoperative/postoperative MI (p < 0.001). Factors associated with decreasing cTnT concentrations during CABG were higher BSA (p < 0.001) and a recent preoperative MI (p < 0.001). The extent of diffuse coronary atherosclerosis and significant stenoses were not associated with changes in cTnT (p = 0.35). Results were similar in the validation cohort.
Left ventricular ejection fraction, New York Heart Association classification, kidney function, inflammation status, duration of cardiopulmonary bypass, body surface area, and preoperative MI were associated with the cTnT rise-and-fall pattern related to myocardial injury after CABG. Information regarding these variables may be valuable when using cTnT in the diagnostic workup of postoperative MI.
研究与冠状动脉旁路移植术（CABG）后心肌损伤相关的肌钙蛋白 T（cTnT）升高的重要临床和手术变量，作为心肌损伤的指标。
前瞻性队列研究。
单所大学医院。
本研究纳入了 2008 年 4 月至 2010 年期间行单纯 CABG 的 626 例患者，以及 2015 年至 2017 年期间的验证队列（n=686 例）。
无。
前瞻性登记围手术期变量。术前冠状动脉造影评估弥漫性冠状动脉粥样硬化和明显狭窄的程度。采用混合模型分析构建一个解释 cTnT 浓度变化的统计模型。该模型调整了术前和术中/术后心肌梗死（MI），以独立评估其他变量。与 CABG 期间和之后 cTnT 浓度升高相关的临床因素包括体外循环时间较长（p<0.001）、术前肌酐较高（p<0.001）、纽约心脏协会功能分级 IV（p=0.006）、左心室射血分数较低（p=0.034）、术前 C 反应蛋白较高（p=0.049）和术中/术后 MI（p<0.001）。与 CABG 期间 cTnT 浓度降低相关的因素包括较高的体表面积（p<0.001）和近期术前 MI（p<0.001）。弥漫性冠状动脉粥样硬化和明显狭窄的程度与 cTnT 的变化无关（p=0.35）。验证队列的结果相似。
左心室射血分数、纽约心脏协会分级、肾功能、炎症状态、体外循环时间、体表面积和术前 MI 与 CABG 后与心肌损伤相关的 cTnT 升高和下降模式相关。在术后 MI 的诊断中使用 cTnT 时，这些变量的信息可能具有价值。
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