非体外循环与体外循环冠状动脉旁路移植术后高敏心肌肌钙蛋白I升高对长期预后的影响

Impact of High-Sensitivity Cardiac Troponin I Elevation After On- and Off-Pump Coronary Artery Bypass Grafting on Long-Term Prognosis.

作者信息

Wang Juncheng, Wang Peng, Liu Hanning, Zhao Yan, Feng Wei, Liu Sheng, Zheng Zhe

机构信息

National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Coronary Heart Disease Risk Prediction and Precision Therapy, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Center of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Can J Cardiol. 2025 Feb;41(2):294-305. doi: 10.1016/j.cjca.2024.10.018. Epub 2024 Oct 26.

DOI:10.1016/j.cjca.2024.10.018

PMID:39490896

Abstract

BACKGROUND

Postoperative myocardial injury is correlated with long-term prognosis after coronary artery bypass grafting (CABG) and is diagnosed according to troponin levels, which vary substantially upon surgical strategies. We aimed to explore the troponin I cutoff values for prognostically significant myocardial injury separately in on-pump and off-pump procedures with the use of a high-sensitivity assay (hs-cTnI).

METHODS

Patients who underwent isolated CABG from 2018 to 2020 with available perioperative hs-cTnI measurements were included in this study. We explored the relationships between hs-cTnI levels and different outcomes. To identify hs-cTnI threshold levels indicative of higher risks, restrictive spline regressions were performed for on-pump and off-pump procedures.

RESULTS

A total of 7813 patients were included with a median follow-up of 2.7 years (interquartile range 1.7-3.3 years), 218 (2.8%) of whom died. Adjusting for clinical variables, the study found a significant association between peak hs-cTnI levels within the first 48 hours after surgery and all end points. The spline regressions demonstrated that the hs-cTnI levels measured within 48 hours after surgery that were associated with a hazard ratio of more than 1.00 for all-cause death were 1446 ng/L (55.6 × upper reference limit [URL], 95% confidence interval [CI] 45.0-106.5 × URL) for on-pump and 564 ng/L (21.7 × URL, 95% CI 21.0-30.2 × URL) for off-pump.

CONCLUSIONS

Elevated hs-cTnI levels after CABG were associated with poorer longer-term outcomes. A prognosis-relevant hs-cTnI cutoff value within 48 hours after CABG for on-pump is significantly higher than that for off-pump.

摘要

背景

术后心肌损伤与冠状动脉旁路移植术（CABG）后的长期预后相关，且根据肌钙蛋白水平进行诊断，而肌钙蛋白水平会因手术策略的不同而有很大差异。我们旨在使用高敏检测法（hs-cTnI）分别探讨在体外循环和非体外循环手术中具有预后意义的心肌损伤的肌钙蛋白I临界值。

方法

本研究纳入了2018年至2020年接受单纯CABG且有围手术期hs-cTnI测量值的患者。我们探讨了hs-cTnI水平与不同结局之间的关系。为了确定表明更高风险的hs-cTnI阈值水平，对体外循环和非体外循环手术进行了限制性样条回归分析。

结果

共纳入7813例患者，中位随访时间为2.7年（四分位间距1.7 - 3.3年），其中218例（2.8%）死亡。在对临床变量进行校正后，研究发现术后48小时内的hs-cTnI峰值水平与所有终点之间存在显著关联。样条回归分析表明，术后48小时内测得的hs-cTnI水平与全因死亡风险比大于1.00相关，体外循环手术为1446 ng/L（55.6×上限参考值[URL]，95%置信区间[CI] 45.0 - 106.5×URL），非体外循环手术为564 ng/L（21.7×URL，95% CI 21.0 - 30.2×URL）。