Cardiac troponin I release after hip surgery correlates with poor long-term cardiac outcome
Cardiac troponin I release after hip surgery correlates with poor long-term cardiac outcome
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DOI：
10.1017/s0265021507001202
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发表时间：
2008-02-01
影响因子：
3.6
通讯作者：
Benhamou, D.
中科院分区：
文献类型：
--
作者：
Ausset, S.;Auroy, Y.;Benhamou, D.
背景和目的：本研究的目的是评估髋关节手术后通过肌钙蛋白1系列测量检测围手术期心肌损伤的发生率及其与晚期心血管结局的相关性。方法：对88例接受髋关节手术的连续患者在术后前三天测量肌钙蛋白I。高于第99百分位数（0.08 ng mL（-1））的值视为阳性。在住院期间和术后1年记录主要心脏事件（心脏性死亡、心肌梗死和心力衰竭）。结果：11例患者（12.5%）在住院期间出现肌钙蛋白I水平升高。其中9人仍然没有病征。在随访期间，其中45916例（5/11）发生了重大心脏事件，而术后肌钙蛋白I水平正常的患者发生率为4%（3/76）（P = 0.0006）。1年时的全因死亡率为36%（4/11）vs. 7%（5/71，P = 0.0131）。使用校正基线数据的多变量考克斯回归分析，与心脏事件发生相关的独立因素为肌钙蛋白I升高（OR = 17.4 - CI 95% 3.7-82）和年龄（OR = 1.1岁-1-CI 95% 1.01-1.21）。全因死亡的独立因素是肌钙蛋白I升高（OR=41.4 - CI 95% 5.4-320.4）和年龄（OR=1.3岁（-1）- CI 95% 1.1-1.4）。结论：肌钙蛋白I释放在髋关节手术后很常见，与肌钙蛋白I水平正常的患者相比，长期主要心脏事件的发生率增加了10倍（45% vs. 4%）。
Background and objective: The aim of this study was to assess the incidence of perioperative myocardial damage detected by serial measurements of troponin 1 after hip surgery and its association with late cardiovascular outcome. Methods: Troponin I was measured during the first three postoperative days in 88 consecutive patients undergoing hip surgery. Values above the 99th percentile (0.08 ng mL(-1)) were considered positive. Major cardiac events (cardiac death, myocardial infarction and cardiac failure) were recorded during hospital stay and 1 yr after surgery. Results: Eleven patients (12.5%) exhibited elevated troponin I levels during hospital stay. Nine of them remained asymptomatic. During follow-up, 45 916 of them (5/11) suffered from a major cardiac event vs. 4% (3/76) for patients with normal postoperative troponin I levels (P = 0.0006). All-cause mortality rate was 36% (4/11) at 1 yr vs. 7% (5/71, P = 0.0131). Using multivariate Cox regression analysis adjusted for baseline data, independent factors associated with the occurrence of a cardiac event were troponin I elevation (OR = 17.4 - CI 95% 3.7-82) and age (OR = 1.1 yr(-1) -CI 95% 1.01-1.21). Independent factors for all-cause mortality were troponin I elevation (OR=41.4 - CI 95% 5.4-320.4), and age (OR=1.3 yr(-1) - CI 95% 1.1-1.4). Conclusion: Troponin I release is common after hip surgery and is associated with a 10-fold increased incidence of long-term major cardiac events as compared to patients with normal troponin I levels (45% vs. 4%).