Carrier M, Pelletier L C, Martineau R, Pellerin M, Solymoss B C
Department of Surgery, Montreal Heart Institute, Quebec, Canada.
J Thorac Cardiovasc Surg. 1998 Jun;115(6):1328-34. doi: 10.1016/S0022-5223(98)70216-8.
Several combinations of risk factors for death or cardiac events after coronary artery bypass grafting have been described. We studied the prognostic value of the preoperative serum levels of cardiac troponin T.
We studied 468 patients who underwent elective coronary artery bypass grafting. Preoperative and postoperative levels of cardiac troponin T and creatine kinase MB, electrocardiograms, clinical data, and events were recorded prospectively. No acute ischemic changes were present on the electrocardiogram before the operations, and preoperative creatine kinase MB serum levels were within normal limits in all patients.
Ninety-seven (97/468, 21%) patients had serum levels of troponin T greater than 0.02 microg/L within 24 hours before coronary artery bypass grafting. Hospital mortality was similar in this group and in the patients with preoperative levels less than 0.02 microg/L (1% in each group). Nine patients (9/97, 9%) with elevated levels of troponin T before the operation had a perioperative myocardial infarction compared with 12 patients (12/371, 3%) among the group with lower troponin T levels (p = 0.015, RR = 2.9). Congestive heart failure occurred in 10 (10/97, 10%) and 8 (8/371,2%) patients, respectively (p = 0.0009, RR = 4.8). Intensive care unit (p = 0.002) and postoperative hospital length of stay (p = 0.09) were all longer in patients with the elevated preoperative troponin T level. In a logistic regression analysis, troponin T level before the operation was the variable most strongly correlated with postoperative myocardial infarction (p = 0.003).
Preoperative troponin T stratification before coronary artery bypass grafting identifies a subgroup of patients with increased risk of postoperative cardiac complications.
已有多项关于冠状动脉搭桥术后死亡或心脏事件风险因素组合的描述。我们研究了术前血清心肌肌钙蛋白T水平的预后价值。
我们对468例行择期冠状动脉搭桥术的患者进行了研究。前瞻性记录术前及术后心肌肌钙蛋白T和肌酸激酶同工酶MB水平、心电图、临床资料及事件。术前心电图无急性缺血改变，所有患者术前肌酸激酶同工酶MB血清水平均在正常范围内。
97例（97/468，21%）患者在冠状动脉搭桥术前24小时内血清肌钙蛋白T水平高于0.02μg/L。该组患者与术前水平低于0.02μg/L的患者的医院死亡率相似（每组均为1%）。术前肌钙蛋白T水平升高的9例患者（9/97，9%）发生围手术期心肌梗死，而肌钙蛋白T水平较低组中有12例患者（12/371，3%）发生围手术期心肌梗死（p = 0.015，RR = 2.9）。充血性心力衰竭分别发生在10例（10/97，10%）和8例（8/371，2%）患者中（p = 0.0009，RR = 4.8）。术前肌钙蛋白T水平升高的患者在重症监护病房的停留时间（p = 0.002）和术后住院时间（p = 0.09）均更长。在逻辑回归分析中，术前肌钙蛋白T水平是与术后心肌梗死相关性最强的变量（p = 0.003）。
冠状动脉搭桥术前肌钙蛋白T分层可识别术后心脏并发症风险增加的患者亚组。
