肌钙蛋白 I 升高与行不停跳冠状动脉手术的患者的长期预后不良相关。

Elevated troponin I is associated with a worse long-term prognosis in patients undergoing beating-heart coronary surgery.

机构信息

Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.

出版信息

Eur J Cardiothorac Surg. 2023 May 2;63(5). doi: 10.1093/ejcts/ezad087.

DOI:10.1093/ejcts/ezad087

PMID:36946289

Abstract

OBJECTIVES

The impacts of elevated troponin I levels after coronary artery bypass grafting (CABG) on long-term outcomes were investigated.

METHODS

A total of 996 patients who underwent elective isolated CABG for stable or unstable angina were enrolled. Patients were divided into higher and lower groups based on 80th percentile postoperative peak troponin I (ppTnI) levels. The relationship between ppTnI and long-term clinical outcomes was analysed.

RESULTS

The median ppTnI was 1.55 (2.74) ng/ml and was significantly higher in the conventional CABG subgroup than in the beating-heart CABG subgroup: 4.04 (4.71) vs 1.24 (1.99) ng/ml, P < 0.001. The 80th percentile of ppTnI was 3.3 ng/ml in the beating-heart CABG subgroup and 8.9 ng/ml in the conventional CABG subgroup. In the conventional CABG subgroup (n = 150), 10-year overall survival showed no significant difference between the higher (≥8.9 ng/ml) and lower (<8.9 ng/ml) ppTnI groups: 71% (10%) vs 76% (5%), P = 0.316. However, the beating-heart CABG subgroup (n = 846) showed significantly worse 10-year overall survival in the higher ppTnI group (≥3.3 ng/ml) than in the lower ppTnI group (<3.3 ng/ml): 64% (6%) vs 73% (3%), P = 0.010. In the beating-heart CABG subgroup, multivariable analysis showed that ppTnI exceeding the 80th percentile was a risk factor for overall death (hazard ratio: 1.505, 95% confidence interval: 1.019-2.225, P = 0.040).

CONCLUSIONS

Higher ppTnI over the 80th percentile was associated with worse long-term survival in beating-heart CABG, but not in conventional CABG.

摘要

目的

研究冠状动脉旁路移植术后（CABG）肌钙蛋白 I 水平升高对长期预后的影响。

方法

共纳入 996 例因稳定或不稳定型心绞痛行择期单纯 CABG 的患者。根据术后第 80 百分位峰值肌钙蛋白 I（ppTnI）水平，将患者分为较高和较低两组。分析 ppTnI 与长期临床结局的关系。

结果

中位 ppTnI 为 1.55（2.74）ng/ml，在常规 CABG 亚组中明显高于心脏不停跳 CABG 亚组：4.04（4.71）比 1.24（1.99）ng/ml，P<0.001。心脏不停跳 CABG 亚组的 ppTnI 第 80 百分位数为 3.3ng/ml，常规 CABG 亚组为 8.9ng/ml。在常规 CABG 亚组（n=150）中，较高（≥8.9ng/ml）和较低（<8.9ng/ml）ppTnI 组 10 年总生存率无显著差异：71%（10%）比 76%（5%），P=0.316。然而，心脏不停跳 CABG 亚组（n=846）中，较高 ppTnI 组（≥3.3ng/ml）10 年总生存率明显低于较低 ppTnI 组（<3.3ng/ml）：64%（6%）比 73%（3%），P=0.010。在心脏不停跳 CABG 亚组中，多变量分析显示，ppTnI 超过第 80 百分位是全因死亡的危险因素（风险比：1.505，95%置信区间：1.019-2.225，P=0.040）。