Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University Basel, Basel, Switzerland.
Br J Anaesth. 2022 Jan;128(1):26-36. doi: 10.1016/j.bja.2021.10.006. Epub 2021 Nov 29.
Patients with perioperative myocardial injury are at risk of death and major adverse cardiovascular and cerebrovascular events (MACCE). The primary aim of this study was to determine optimal thresholds of preoperative and perioperative changes in high-sensitivity cardiac troponin T (hs-cTnT) to predict MACCE and mortality.
Prospective, observational, cohort study in patients ≥50 yr of age undergoing elective major noncardiac surgery at seven hospitals in Sweden. The exposures were hs-cTnT measured before and days 0-3 after surgery. Two previously published thresholds for myocardial injury and two thresholds identified using receiver operating characteristic analyses were evaluated using multivariable logistic regression models and externally validated. The weighted comparison net benefit method was applied to determine the additional value of hs-cTnT thresholds when compared with the Revised Cardiac Risk Index (RCRI). The primary outcome was a composite of 30-day all-cause mortality and MACCE.
We included 1291 patients between April 2017 and December 2020. The primary outcome occurred in 124 patients (9.6%). Perioperative increase in hs-cTnT ≥14 ng L above preoperative values provided statistically optimal model performance and was associated with the highest risk for the primary outcome (adjusted odds ratio 2.9, 95% confidence interval 1.8-4.7). Validation in an independent, external cohort confirmed these findings. A net benefit over RCRI was demonstrated across a range of clinical thresholds.
Perioperative increases in hsTnT ≥14 ng L above baseline values identifies acute perioperative myocardial injury and provides a net prognostic benefit when added to RCRI for the identification of patients at high risk of death and MACCE.
NCT03436238.
围手术期心肌损伤患者有死亡和主要不良心血管和脑血管事件（MACCE）的风险。本研究的主要目的是确定术前和围手术期高敏心肌肌钙蛋白 T（hs-cTnT）变化的最佳阈值，以预测 MACCE 和死亡率。
在瑞典的 7 家医院对年龄≥50 岁接受择期非心脏大手术的患者进行前瞻性、观察性队列研究。暴露因素为手术前和手术后 0-3 天测量的 hs-cTnT。使用多变量逻辑回归模型评估并外部验证了两种先前发表的心肌损伤阈值和两种使用接收者操作特征分析确定的阈值。应用加权比较净效益法来确定与修订后的心脏风险指数（RCRI）相比 hs-cTnT 阈值的附加价值。主要结局是 30 天全因死亡率和 MACCE 的复合结局。
我们纳入了 2017 年 4 月至 2020 年 12 月期间的 1291 名患者。主要结局发生在 124 名患者（9.6%）中。hs-cTnT 术前值以上的围手术期增加≥14ng/L 提供了统计学上最佳的模型性能，与主要结局的最高风险相关（调整后的优势比 2.9，95%置信区间 1.8-4.7）。在一个独立的外部队列中的验证证实了这些发现。在一系列临床阈值上，与 RCRI 相比显示出净效益。
hsTnT 术前值以上的围手术期增加≥14ng/L 可识别急性围手术期心肌损伤，并在添加到 RCRI 以识别高死亡和 MACCE 风险的患者时提供净预后获益。
NCT03436238。
