心肌损伤标志物峰时间对 OPCABG 患者中期结局的影响。

Effects of peak time of myocardial injury biomarkers on mid-term outcomes of patients undergoing OPCABG.

机构信息

Department of Cardiology, Shanghai East Hospital, School of Medicine,Tongji University, Shanghai, China.

Cardiovascular Department, Huaiyin Hospital of Huai'an City, Huai'an, China.

出版信息

BMC Cardiovasc Disord. 2021 Apr 24;21(1):208. doi: 10.1186/s12872-021-02006-5.

DOI:10.1186/s12872-021-02006-5

PMID:33894740

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8066968/

Abstract

BACKGROUND

With the development of cardiac surgery techniques, myocardial injury is gradually reduced, but cannot be completely avoided. Myocardial injury biomarkers (MIBs) can quickly and specifically reflect the degree of myocardial injury. Due to various reasons, there is no consensus on the specific values of MIBs in evaluating postoperative prognosis. This retrospective study was aimed to investigate the impact of MIBs on the mid-term prognosis of patients undergoing off-pump coronary artery bypass grafting (OPCABG).

METHODS

Totally 564 patients undergoing OPCABG with normal courses were included. Cardiac troponin T (cTnT) and creatine kinase myocardial band (CK-MB) were assessed within 48 h before operation and at 6, 12, 24, 48, 72, 96 and 120 h after operation. Patients were grouped by peak values and peak time courses of MIBs. The profile of MIBs and clinical variables as well as their correlations with mid-term prognosis were analyzed by univariable and multivariable Cox regression models.

RESULT

Continuous assessment showed that MIBs increased first (12 h after surgery) and then decreased. The peak cTnT and peak CK-MB occurred within 24 h after operation in 76.8% and 67.7% of the patients respectively. No significant correlation was found between CK-MB and mid-term mortality. Delayed cTnT peak (peak cTnT elevated after 24 h after operation) was correlated with lower creatinine clearance rate (69.36 ± 21.67 vs. 82.18 ± 25.17 ml/min/1.73 m), body mass index (24.35 ± 2.58 vs. 25.27 ± 3.26 kg/m), less arterial grafts (1.24 ± 0.77 vs. 1.45 ± 0.86), higher EuroSCORE II (2.22 ± 1.12 vs.1.72 ± 0.91) and mid-term mortality (26.5 vs.7.9%). Age (HR: 1.067, CI: 1.006-1.133), left ventricular ejection fraction (HR: 0.950, CI: 0.910-0.993), New York Heart Association score (HR: 1.839, CI: 1.159-2.917), total venous grafting (HR: 2.833, CI: 1.054-7.614) and cTnT peak occurrence within 24 h (HR: 0.362, CI: 0.196-0.668) were independent predictors of mid-term mortality.

CONCLUSION

cTnT is a better indicator than CK-MB. The peak value and peak occurrence of cTnT are related to mid-term mortality in patients undergoing OPCABG, and the peak phases have stronger predictive ability.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR2000033850. Registered 14 June 2020, http://www.chictr.org.cn/edit.aspx?pid=55162&htm=4 .

摘要

背景

随着心脏外科技术的发展，心肌损伤逐渐减少，但仍无法完全避免。心肌损伤标志物（MIBs）可以快速、特异性地反映心肌损伤程度。由于各种原因，MIBs 在评估术后预后方面的具体值尚未达成共识。本回顾性研究旨在探讨 MIBs 对非体外循环冠状动脉旁路移植术（OPCABG）患者中期预后的影响。

方法

共纳入 564 例手术过程正常的 OPCABG 患者。在术前 48 小时内和术后 6、12、24、48、72、96 和 120 小时评估心脏肌钙蛋白 T（cTnT）和肌酸激酶同工酶 MB（CK-MB）。根据 MIBs 的峰值和峰值时间曲线将患者分组。通过单变量和多变量 Cox 回归模型分析 MIBs 特征和临床变量及其与中期预后的相关性。

结果

连续评估显示，MIBs 先升高（术后 12 小时），然后下降。76.8%和 67.7%的患者在术后 24 小时内出现峰值 cTnT 和峰值 CK-MB。CK-MB 与中期死亡率无显著相关性。cTnT 峰值延迟（术后 24 小时后 cTnT 升高）与肌酐清除率较低（69.36±21.67 与 82.18±25.17 ml/min/1.73 m）、体重指数较高（24.35±2.58 与 25.27±3.26 kg/m）、动脉旁路移植术较少（1.24±0.77 与 1.45±0.86）、EuroSCORE II 较高（2.22±1.12 与 1.72±0.91）和中期死亡率较高（26.5%与 7.9%）相关。年龄（HR：1.067，CI：1.006-1.133）、左心室射血分数（HR：0.950，CI：0.910-0.993）、纽约心功能分级（HR：1.839，CI：1.159-2.917）、总静脉旁路移植术（HR：2.833，CI：1.054-7.614）和 cTnT 峰值发生在术后 24 小时内（HR：0.362，CI：0.196-0.668）是中期死亡率的独立预测因子。