Department of Cardiothoracic Surgery, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
Department of Cardiothoracic Surgery, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
Heart Lung Circ. 2021 Oct;30(10):1562-1569. doi: 10.1016/j.hlc.2021.03.272. Epub 2021 Apr 28.
High-sensitivity troponin T (hs-TnT), as a single or serial measurement to predict postoperative mortality and morbidity, appears to be attractive due to its direct relationship in assessing myocardial damage and the widespread availability of hs-TnT testing. Therefore, this study aimed to identify any prognostic value of hs-TnT in predicting in-hospital outcomes after coronary artery bypass graft (CABG) surgery.
We identified all consecutive patients who underwent on-pump CABG between July 2011 and December 2018. To evaluate the prognostic value of hs-TnT after CABG, we assessed the probability and odds ratio (OR) of adverse events concerning the maximum value of postoperative hs-TnT (measured within 24 hrs). TnT was routinely collected at 0, 6, 12 and 72 hours postoperatively. Values were categorised into intervals of 200 for analysis. A fully Bayesian logistic regression of the adverse event with the troponin T interval (0-200) as the reference level was used. A subgroup analysis was performed in patients with normal and elevated preoperative hs-TnT (< or ≥30 ng/L). The pre-specified primary outcome was a major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of death within 30 days of operation for any cause, myocardial infection (MI), or stroke.
1,318 people underwent on-pump CABG during this period. One hundred and twenty-three (123) (9.3%) experienced MACCE, 14 (1.1%) experienced death within 30 days, 105 (8.0%) experienced MI and 14 (1.1%) experienced stroke. Compared to the reference category (hs-TnT ≤200 ng/L) we found there was an increase in OR with increasing level of hs-TnT for MACCE (p<0.001), 30-day mortality (p=0.003), MI (p<0.001) and ICU stay >48 hours (p<0.001). However, there was no statistically significant association present between hs-TnT and stroke, readmission to the intensive care unit (ICU), return to theatre for bleeding, or new-onset renal dysfunction.
Peak hs-TnT level, greater than 400 ng/L, measured within 24 hours after CABG surgery is associated with MACCE, 30-day mortality, MI and ICU stay >48 hours. Prospectively designed trials, with clear prognostic and outcome variables, may provide further insight into the prognostic value of hs-TnT post-CABG.
高敏肌钙蛋白 T（hs-TnT）作为一种单一或连续的测量指标，用于预测术后死亡率和发病率，由于其在评估心肌损伤方面的直接关系以及 hs-TnT 检测的广泛应用，因此具有吸引力。因此，本研究旨在确定 hs-TnT 在预测冠状动脉旁路移植术（CABG）后住院期间结局方面的任何预后价值。
我们确定了 2011 年 7 月至 2018 年 12 月期间接受体外循环 CABG 的所有连续患者。为了评估 CABG 后 hs-TnT 的预后价值，我们评估了术后 hs-TnT 最大值（术后 24 小时内测量）与不良事件之间的概率和优势比（OR）。TnT 通常在术后 0、6、12 和 72 小时采集。根据分析将值分为 200 的间隔。使用 troponin T 间隔（0-200）作为参考水平的全贝叶斯逻辑回归来分析不良事件。对术前 hs-TnT 正常和升高的患者（<或≥30ng/L）进行了亚组分析。预先指定的主要结局是主要不良心脏或脑血管事件（MACCE），定义为任何原因导致的 30 天内手术相关死亡、心肌感染（MI）或中风的复合事件。
在此期间，有 1318 人接受了体外循环 CABG。123（9.3%）人发生了 MACCE，14（1.1%）人在 30 天内死亡，105（8.0%）人发生了 MI，14（1.1%）人发生了中风。与参考类别（hs-TnT≤200ng/L）相比，我们发现随着 hs-TnT 水平的升高，MACCE（p<0.001）、30 天死亡率（p=0.003）、MI（p<0.001）和 ICU 住院时间>48 小时（p<0.001）的 OR 增加。然而，hs-TnT 与中风、ICU 再次入院、因出血返回手术室或新发肾功能不全之间无统计学显著关联。
CABG 术后 24 小时内测量的 hs-TnT 峰值>400ng/L 与 MACCE、30 天死亡率、MI 和 ICU 住院时间>48 小时有关。可能需要前瞻性设计的试验，结合明确的预后和结局变量，以进一步了解 CABG 后 hs-TnT 的预后价值。
