Rudolph Felix, Deutsch Marcus-André, Friedrichs Kai Peter, Renner André, Scholtz Werner, Gerçek Muhammed, Kirchner Johannes, Ayoub Mohamed, Rudolph Tanja Katharina, Schramm René, Gummert Jan, Rudolph Volker, Omran Hazem
Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Medical School and University Medical Center OWL, Universität Bielefeld, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
Clin Res Cardiol. 2025 Jan 29. doi: 10.1007/s00392-025-02595-7.
Impaired renal function can increase cardiac troponin levels due to reduced elimination, potentially affecting its diagnostic utility. Limited data exist on high-sensitivity cardiac troponin I (hs-cTnI) kinetics after cardiac surgery relative to renal function. This study evaluates how impaired renal function influences hs-cTnI kinetics following cardiac surgery, distinguishing between patients with and without postoperative myocardial infarction (PMI).
We conducted a retrospective analysis of adult patients who underwent elective cardiac surgery at our hospital from January 2013 to May 2019. Serial hs-cTnI measurements were taken from baseline up to 48 h post-surgery. Renal function was assessed using the MDRD formula, defining impaired renal function as a GFR < 60 ml/min. Acute kidney injury (AKI) was based on postoperative creatinine levels, and PMI was defined by ARC-2 criteria. Predictors of long-term all-cause mortality were analyzed using Cox regression.
Out of 14,355 patients (51.4% CABG, 39.4% valvular procedures, 9.2% thoracic aortic procedures), 139 (1.0%) had PMI. Hs-cTnI levels were higher in patients with impaired renal function across the cohort and in those without PMI. However, in patients with PMI, hs-cTnI levels did not vary significantly with renal function. Elevated hs-cTnI ≥ 213 times the upper limit of normal was a significant predictor of long-term mortality regardless of renal function (hazard ratio: 1.28, 95% CI: 1.17-1.40, p < 0.001), but early postoperative hs-cTnI measures held poor discriminatory yield to predict PMI with an AUC of 0.55 (95% confidence intervals: 0.54-0.56).
Renal function and acute kidney injury affect hs-cTnI kinetics post-surgery only in patients without PMI. Elevated hs-cTnI remains a strong predictor of long-term mortality, independent of renal function, but early postoperative detection of PMI requires additional metrics, including ECG, transthoracic echocardiography (TTE), and signs of hemodynamic instability.
肾功能受损可因清除减少而导致心肌肌钙蛋白水平升高，这可能会影响其诊断效用。关于心脏手术后高敏心肌肌钙蛋白I（hs-cTnI）动力学相对于肾功能的数据有限。本研究评估肾功能受损如何影响心脏手术后hs-cTnI动力学，区分有无术后心肌梗死（PMI）的患者。
我们对2013年1月至2019年5月在我院接受择期心脏手术的成年患者进行了回顾性分析。从基线到术后48小时进行连续hs-cTnI测量。使用MDRD公式评估肾功能，将肾功能受损定义为肾小球滤过率（GFR）<60ml/分钟。急性肾损伤（AKI）基于术后肌酐水平，PMI根据ARC-2标准定义。使用Cox回归分析长期全因死亡率的预测因素。
在14355例患者中（51.4%为冠状动脉旁路移植术，39.4%为瓣膜手术，9.2%为胸主动脉手术），139例（1.0%）发生PMI。整个队列中肾功能受损的患者以及无PMI的患者hs-cTnI水平较高。然而，在有PMI的患者中，hs-cTnI水平并未随肾功能显著变化。无论肾功能如何，hs-cTnI升高≥正常上限的213倍是长期死亡率的重要预测因素（风险比：1.28，95%置信区间：1.17-1.40，p<0.001），但术后早期hs-cTnI测量对预测PMI的鉴别能力较差，曲线下面积（AUC）为0.55（95%置信区间：0.54-0.56）。
仅在无PMI的患者中，肾功能和急性肾损伤会影响术后hs-cTnI动力学。hs-cTnI升高仍然是长期死亡率的有力预测因素，与肾功能无关，但术后早期检测PMI需要额外的指标，包括心电图、经胸超声心动图（TTE）和血流动力学不稳定的体征。
