Department of Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
BMJ Open. 2021 Jun 18;11(6):e046223. doi: 10.1136/bmjopen-2020-046223.
Myocardial injury after noncardiac surgery has been recognised as an important complication associated with short-term and long-term morbidity and mortality. However, whether a higher level of postoperative cardiac troponin (cTn) is associated with a higher incidence of major complications remains controversial. Hence, we will conduct a comprehensive dose-response meta-analysis based on all relevant prospective studies to quantitatively evaluate the association between elevated postoperative cTn levels and short-/long-term adverse clinical outcomes following adult noncardiac surgery.
We will search the PubMed, EMBase, Cochrane Library, ISI Knowledge via Web of Science, China National Knowledge Infrastructure, Wanfang and VIP databases (from inception until October 2020) to identify all prospective cohort studies using the relevant keywords. The primary outcome will be all-cause mortality. The secondary outcomes will include cardiovascular mortality and major adverse cardiovascular events (MACEs). Univariable or multivariable meta-regression and subgroup analyses will be conducted for the comparison between elevated versus nonelevated categories of postoperative cTn levels. Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of all-cause mortality or MACE. To conduct a dose-response meta-analysis for the potential linear or restricted cubic spline regression relationship between postoperative elevated cTn levels and all-cause mortality or MACE, studies with three or more categories will be included.
Ethical approval is waived for the systematic review protocol according to the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication and conference presentations.
CRD42020173175.
非心脏手术后心肌损伤已被认为是与短期和长期发病率和死亡率相关的重要并发症。然而，术后心脏肌钙蛋白（cTn）水平升高是否与更高的主要并发症发生率相关仍存在争议。因此，我们将基于所有相关的前瞻性研究进行全面的剂量-反应荟萃分析，定量评估术后 cTn 水平升高与成人非心脏手术后短期/长期不良临床结局之间的关系。
我们将检索 PubMed、EMBase、Cochrane 图书馆、ISI Web of Science 知识、中国国家知识基础设施、万方和 VIP 数据库（从建库起至 2020 年 10 月），以确定所有使用相关关键词的前瞻性队列研究。主要结局将是全因死亡率。次要结局将包括心血管死亡率和主要不良心血管事件（MACEs）。将进行单变量或多变量荟萃回归和亚组分析，以比较术后 cTn 水平升高与不升高类别之间的差异。敏感性分析将用于通过每次删除一项纳入研究来评估我们的结果的稳健性，以获得和评估全因死亡率或 MACE 的剩余总体估计值。为了对术后升高的 cTn 水平与全因死亡率或 MACE 之间的潜在线性或限制立方样条回归关系进行剂量-反应荟萃分析，将纳入有三个或更多类别的研究。
根据阜外医院的机构审查委员会/独立伦理委员会，本系统评价方案不需要伦理批准。本荟萃分析将通过同行评审的期刊发表，并在会议上展示。
PROSPERO 注册号：CRD42020173175。
