Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
PLoS One. 2020 Jul 2;15(7):e0234776. doi: 10.1371/journal.pone.0234776. eCollection 2020.
Perioperative myocardial injury is a predictor of postoperative mortality, but the clinical impact of chronic injury during the perioperative period has not been fully investigated. This study aimed to evaluate chronic myocardial injury during the perioperative period in comparison with normal and acute myocardial injury.
Patients with serial cardiac troponin measurements before and within 30 days following noncardiac surgery were divided into three groups: normal, acute injury, and chronic injury groups. Acute and chronic myocardial injuries were stratified according to 2018 recommendations by the International Federation of Clinical Chemistry and Laboratory Medicine's Task Force on Clinical Applications of Bio-Markers. Thirty-day and one-year mortalities after surgery were compared.
Of the 22,969 patients reviewed, 17,671 (76.9%) were classified into the normal, 5,179 (22.5%) into the acute injury, and 119 (0.5%) into the chronic injury groups. The acute and chronic injury groups had higher 30-day mortalities compared with the normal group (0.8% vs. 8.0%; hazard ratio [HR], 11.00; 95% confidence interval [CI], 9.05-13.37; P < 0.001 and 0.8% vs. 7.6%; HR, 10.55; 95% CI, 5.37-20.72; P < 0.001, respectively). In a direct comparison between the acute and chronic injury groups using an inverse probability of weighting adjustments, the 30-day and one-year mortalities were not significantly different.
Chronic myocardial injury during the perioperative period may show similar clinical impacts on postoperative mortality compared with acute injury. Further studies are needed.
围术期心肌损伤是术后死亡率的预测指标，但围术期慢性损伤的临床影响尚未得到充分研究。本研究旨在评估围术期慢性心肌损伤与正常和急性心肌损伤的关系。
将术前和术后 30 天内连续进行心脏肌钙蛋白检测的患者分为三组：正常组、急性损伤组和慢性损伤组。根据国际临床化学和实验室医学联合会生物标志物临床应用工作组 2018 年的建议，对急性和慢性心肌损伤进行分层。比较术后 30 天和 1 年的死亡率。
在回顾的 22969 例患者中，17671 例（76.9%）归入正常组，5179 例（22.5%）归入急性损伤组，119 例（0.5%）归入慢性损伤组。与正常组相比，急性和慢性损伤组的 30 天死亡率更高（0.8%比 8.0%；危险比[HR]，11.00；95%置信区间[CI]，9.05-13.37；P<0.001 和 0.8%比 7.6%；HR，10.55；95%CI，5.37-20.72；P<0.001）。通过使用逆概率加权调整进行急性和慢性损伤组之间的直接比较，30 天和 1 年的死亡率没有显著差异。
围术期慢性心肌损伤可能与急性损伤一样，对术后死亡率有类似的临床影响。需要进一步研究。
