Department of Internal Medicine, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brazil; Cardiology Discipline, Departamento de Medicina Especializada (DEMESP), Escola de Medicina e Cirurgia, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.
Department of Internal Medicine, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brazil.
Clinics (Sao Paulo). 2024 Mar 12;79:100342. doi: 10.1016/j.clinsp.2024.100342. eCollection 2024.
The authors conducted a prospective observational study to investigate the prognostic value of high-sensitivity Troponin I (hs-TnI) in the short- and long-term periods after orthopedic surgery, including Total Hip and Knee Arthroplasty (THA and TKA, respectively), in a tertiary orthopedic center in Brazil. Perioperative Myocardial Injury (PMI) was defined as an absolute increase in hs-TnI of ≥ 26 ng/L above preoperative values. The primary endpoint was all-cause mortality assessed at 30 days and 18 months after surgery. The secondary endpoint consisted of a composite outcome: cardiovascular death, acute myocardial infarction, angina requiring revascularization, and/or stroke. The authors compared Relative Risks (RR) of all-cause mortality and composite outcomes in patients with or without PMI at 30 days and 18 months. A Cox proportional hazards model for long-term outcomes was calculated and adjusted for age > 70 years, gender, and Revised Cardiac Risk Index (RCRI) class ≥ 2. PMI occurred in 3.4 % of all surgeries. At 30-days, 6.6 % of patients with PMI had died versus none without PMI. At 18 months, 20.0 % of PMI versus 4.7 % without PMI had died (RR = 5.0; 95 % Confidence Interval [95 % CI 1.3-19.3]). Based on composite outcomes in short and long-term periods, the RRs were 16.2 (95 % CI 2.7-96.5) and 7.7 (95 % CI 2.2-26.6), respectively. PMI was associated with all-cause mortality after 18 months and increased risk for a composite outcome (Hazard Ratio [HR = 3.97], 95 % CI 1.13-13.89 and HR = 5.80, 95 % CI 1.93-17.45, respectively). Patients with PMI who underwent THA or TKA presented worse short- and long-term prognoses compared to those without PMI.
作者在巴西的一家三级骨科中心进行了一项前瞻性观察研究，旨在探讨高敏肌钙蛋白 I（hs-TnI）在骨科手术后短期和长期预后中的价值，包括全髋关节置换术（THA）和全膝关节置换术（TKA）。围手术期心肌损伤（PMI）定义为 hs-TnI 绝对值较术前升高≥26ng/L。主要终点是术后 30 天和 18 个月的全因死亡率。次要终点是复合终点：心血管死亡、急性心肌梗死、需要血运重建的心绞痛和/或中风。作者比较了 30 天和 18 个月时发生 PMI 和未发生 PMI 的患者的全因死亡率和复合终点的相对风险（RR）。计算了用于长期结果的 Cox 比例风险模型，并按年龄>70 岁、性别和修订后的心脏风险指数（RCRI）等级≥2 进行了调整。所有手术中，PMI 的发生率为 3.4%。术后 30 天，PMI 患者中有 6.6%死亡，而无 PMI 患者中无一人死亡。术后 18 个月，PMI 患者中有 20.0%死亡，而无 PMI 患者中有 4.7%死亡（RR=5.0；95%置信区间[95%CI]1.3-19.3）。基于短期和长期的复合终点，RR 分别为 16.2（95%CI 2.7-96.5）和 7.7（95%CI 2.2-26.6）。术后 18 个月，PMI 与全因死亡率相关，并增加了复合终点的风险（风险比[HR]=3.97，95%CI 1.13-13.89 和 HR=5.80，95%CI 1.93-17.45）。与无 PMI 相比，接受 THA 或 TKA 的 PMI 患者的短期和长期预后更差。
