Departments of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Br J Surg. 2020 Jan;107(2):e81-e90. doi: 10.1002/bjs.11305.
Patients undergoing major non-cardiac surgery are at risk of cardiovascular complications. Raised levels of high-sensitivity troponin are frequently detected before operation among these patients. However, the prognostic value of high-sensitivity troponin in predicting postoperative outcomes remains unclear.
A systematic search of PubMed, Embase and Science Citation Index Expanded was undertaken for observational studies published before March 2018 that reported associations between raised preoperative levels of high-sensitivity troponin and postoperative major adverse cardiac events and/or mortality after non-cardiac surgery. Meta-analyses were performed, where possible, using random-effects models.
Seven cohort studies with a total of 4836 patients were included. A raised preoperative high-sensitivity troponin level was associated with a higher risk of short-term major adverse cardiac events (risk ratio (RR) 2·92, 95 per cent c.i. 1·96 to 4·37; I = 82·6 per cent), short-term mortality (RR 5·39, 3·21 to 9·06; I = 0 per cent) and long-term mortality (RR 2·90, 1·83 to 4·59, I = 74·2 per cent). The addition of preoperative high-sensitivity troponin measurement provided improvements in cardiovascular risk discrimination (increase in C-index ranged from 0·058 to 0·109) and classification (quantified by continuous net reclassification improvement) compared with Lee's Revised Cardiac Risk Index alone. There was substantial heterogeneity and inadequate risk stratification analysis in the included studies.
Raised preoperative levels of high-sensitivity troponin appear to represent a risk for postoperative major adverse cardiac events and mortality. Further study is required before high-sensitivity troponin can be used to predict risk stratification in routine clinical practice.
接受非心脏大手术的患者存在心血管并发症的风险。这些患者在术前经常检测到高敏肌钙蛋白水平升高。然而，高敏肌钙蛋白预测术后结局的预后价值尚不清楚。
系统检索了 2018 年 3 月前发表的观察性研究，这些研究报告了术前高敏肌钙蛋白升高与非心脏手术后短期主要不良心脏事件和/或死亡率之间的关系。在可能的情况下，使用随机效应模型进行了荟萃分析。
共纳入 7 项队列研究，共 4836 例患者。术前高敏肌钙蛋白升高与短期主要不良心脏事件（风险比 2.92，95%可信区间 1.96 至 4.37；I ² = 82.6%）、短期死亡率（RR 5.39，3.21 至 9.06；I ² = 0%）和长期死亡率（RR 2.90，1.83 至 4.59，I ² = 74.2%）风险增加相关。与单独使用 Lee 修订心脏风险指数相比，术前高敏肌钙蛋白测量可改善心血管风险分层（C 指数增加范围为 0.058 至 0.109）和分类（通过连续净重新分类改善来量化）。纳入的研究存在较大的异质性和不足的风险分层分析。
术前高敏肌钙蛋白水平升高似乎代表了术后主要不良心脏事件和死亡率的风险。在高敏肌钙蛋白可用于常规临床实践风险分层之前，需要进一步研究。
