Park Jungchan, Hyeon Cheol Won, Lee Seung Hwa, Kim Jihoon, Kwon Ji Hye, Yang Kwangmo, Min Jeong Jin, Lee Jong Hwan, Lee Sangmin Maria, Yang Jeong Hoon, Song Young Bin, Hahn Joo Yong, Choi Jin Ho, Choi Seung Hyuk, Kim Kyunga, Ahn Joonghyun, Gwon Hyeon Cheol
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean Circ J. 2020 Oct;50(10):925-937. doi: 10.4070/kcj.2020.0088. Epub 2020 Jul 24.
In patients with perioperative cardiac troponin (cTn) I below the 99th-percentile upper range of limit (URL), mortality according to cTn I level has not been fully evaluated. This study evaluated the association between postoperative cTn I level above the lowest limit of detection but within the 99th-percentile URL and 30-day mortality after noncardiac surgery.
Patients with cTn I values below the 99th-percentile URL during the perioperative period were divided into a no-elevation group with cTn I at the lowest limit of detection (6 ng/L) and a minor elevation group with cTn I elevation below the 99th percentile URL (6 ng/L < cTn I < 40 ng/L). The primary outcome was 30-day mortality.
Of the 5,312 study participants, 2,582 (48.6%) were included in the no-elevation group and 2,730 (51.4%) were included in the minor elevation group. After propensity score-matching, the minor elevation group showed significantly increased 30-day mortality (0.5% vs. 2.3%; hazard ratio, 4.30; 95% confidence interval, 2.23-8.29; p<0.001). The estimated cutoff value of cTn I to predict 30-day mortality was 6 ng/L with the area under the receiver operating characteristic curve 0.657.
A mild elevation of cTn I within the 99th-percentile URL after noncardiac surgery was significantly associated with increased 30-day mortality as compared with the lowest limit of detection.
Clinical Research Information Service Identifier: KCT0004244.
对于围手术期心肌肌钙蛋白（cTn）I低于第99百分位数上限（URL）的患者，根据cTn I水平评估的死亡率尚未得到充分评估。本研究评估了非心脏手术后cTn I水平高于检测下限但在第99百分位数URL范围内与30天死亡率之间的关联。
将围手术期cTn I值低于第99百分位数URL的患者分为cTn I处于检测下限（6 ng/L）的无升高组和cTn I升高低于第99百分位数URL（6 ng/L < cTn I < 40 ng/L）的轻度升高组。主要结局为30天死亡率。
在5312名研究参与者中，2582名（48.6%）被纳入无升高组，2730名（51.4%）被纳入轻度升高组。经过倾向评分匹配后，轻度升高组的30天死亡率显著增加（0.5%对2.3%；风险比，4.30；95%置信区间，2.23 - 8.29；p<0.001）。预测30天死亡率的cTn I估计临界值为6 ng/L，受试者工作特征曲线下面积为0.657。
与检测下限相比，非心脏手术后cTn I在第99百分位数URL范围内的轻度升高与30天死亡率增加显著相关。
临床研究信息服务标识符：KCT0004244。
