Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Department of Statistics, University of Warwick, Coventry, United Kingdom.
J Am Coll Cardiol. 2023 Sep 26;82(13):1301-1312. doi: 10.1016/j.jacc.2023.07.011.
The relevance of perioperative myocardial injury (PMI) after cardiac surgery for 30-day mortality and long-term survival remains to be determined.
This study assessed the association of PMI after cardiac surgery, reflected by postoperative troponin release, with 30-day mortality and long-term survival after: 1) coronary artery bypass grafting (CABG); 2) isolated aortic valve replacement (AVR) surgery; and 3) all other cardiac surgeries.
A consecutive cohort of 8,292 patients undergoing cardiac surgery with serial perioperative high-sensitivity cardiac troponin T (hs-cTnT) measurements was retrospectively analyzed. The relationship between postoperative hs-cTnT release and 30-day mortality or 5-year mortality was analyzed after adjustment with EuroSCORE II using a Cox proportional hazards model. hs-cTnT thresholds for 30-day and 5-year mortality were determined for isolated CABG (32.3%), AVR (14%), and other cardiac surgery (53.8%).
High postoperative hs-cTnT levels were associated with higher 30-day mortality but not 5-year mortality. In CABG, median peak concentration of postoperative hs-cTnT was 1,044 ng/L, in AVR it was 502 ng/L, and in other cardiac surgery it was 1,110 ng/L. hs-cTnT thresholds defining mortality-associated PMI were as follows: for CABG, 2,385 ng/L (170× the upper reference limit of normal in a seemingly healthy population [URL]); for AVR, 568 ng/L (41× URL); and for other cardiac procedures, 1,873 ng/L (134× URL). hs-cTnT levels above the cutoffs resulted in an HR for 30-day mortality for CABG of 12.56 (P < 0.001), for AVR of 4.44 (P = 0.004), and for other cardiac surgery of 3.97 (P < 0.001).
PMI reflected by perioperative hs-cTnT release is associated with the expected 30-day mortality but not 5-year mortality. Postoperative hs-cTnT cutoffs to identify survival-relevant PMI are higher than suggested in current definitions.
心脏手术后围手术期心肌损伤（PMI）与 30 天死亡率和长期生存率的相关性仍有待确定。
本研究评估了心脏手术后肌钙蛋白释放反映的 PMI 与 30 天死亡率和长期生存率之间的关系：1）冠状动脉旁路移植术（CABG）；2）单纯主动脉瓣置换术（AVR）；以及 3）所有其他心脏手术。
回顾性分析了连续队列 8292 例接受心脏手术并进行连续围手术期高敏心肌肌钙蛋白 T（hs-cTnT）测量的患者。使用 Cox 比例风险模型，使用 EuroSCORE II 进行调整后，分析术后 hs-cTnT 释放与 30 天死亡率或 5 年死亡率之间的关系。确定了单纯 CABG（32.3%）、AVR（14%）和其他心脏手术（53.8%）术后 30 天和 5 年死亡率的 hs-cTnT 阈值。
高术后 hs-cTnT 水平与 30 天死亡率较高相关，但与 5 年死亡率无关。在 CABG 中，术后 hs-cTnT 峰值浓度中位数为 1044ng/L，在 AVR 中为 502ng/L，在其他心脏手术中为 1110ng/L。定义与 PMI 相关的死亡率的 hs-cTnT 阈值如下：CABG，2385ng/L（在看似健康人群的正常上限的 170 倍[URL]）；AVR，568ng/L（41×URL）；其他心脏手术，1873ng/L（134×URL）。hs-cTnT 水平超过临界值，导致 CABG 的 30 天死亡率的 HR 为 12.56（P<0.001），AVR 为 4.44（P=0.004），其他心脏手术为 3.97（P<0.001）。
由围手术期 hs-cTnT 释放反映的 PMI 与预期的 30 天死亡率相关，但与 5 年死亡率无关。确定与生存相关的 PMI 的术后 hs-cTnT 截止值高于当前定义中建议的值。
