Elevated Admission Cardiac Troponin I Predicts Adverse Outcomes of Acute Type B Aortic Dissection after Endovascular Treatment.
Elevated Admission Cardiac Troponin I Predicts Adverse Outcomes of Acute Type B Aortic Dissection after Endovascular Treatment.
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入院时心肌肌钙蛋白 I 升高可预测急性 B 型主动脉夹层血管内治疗后的不良后果
DOI：
10.3389/fsurg.2022.789954
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发表时间：
2022
影响因子：
1.8
通讯作者：
Jing, Zaiping
中科院分区：
文献类型：
--
作者：
Zhao, Kaiwen;Zhu, Hongqiao;Zhang, Lei;Liu, Junjun;Pei, Yifei;Zhou, Jian;Jing, Zaiping
关键词：
血清心肌肌钙蛋白I （cTnI）对急性B型主动脉夹层（aTBAD）患者胸血管内主动脉修复（TEVAR）术后长期不良结局的预测作用尚缺乏证据。在这项研究中，我们确定了cTnI是否是TEVAR后aTBAD患者5年不良结局的独立危险因素。我们回顾了因TEVAR入院的连续无心脏病的aTBAD患者。根据受试者时变工作特征曲线分析将总研究人群分为cTnI（+）组（≥0.03 ng/mL）和cTnI（-）组（<0.03 ng/mL）。比较两组患者的临床特点、手术细节及临床转归的差异。两组之间的年龄和男性患病率没有差异。与cTnI（−）组相比，cTnI≥0.03 ng/mL的患者慢性肾脏疾病的发生率更高。此外，cTnI（+）组出现更频繁的早搏和非心肌梗死性ST-T段改变。在实验室检查方面，cTnI（+）组患者白细胞计数、中性粒细胞计数、血清d -二聚体和血清纤维蛋白降解产物均升高，而淋巴细胞和血小板计数下降。cTnI升高的患者发生5年主动脉相关不良事件的风险增加（风险比，HR = 1.822, 95%可信区间，CI: 1.094-3.035; p = 0.021），全因死亡率增加（HR = 4.009, 95% CI: 2.175-7.388; p < 0.001）。在没有既往心脏病的aTBAD患者中，术前cTnI升高确定了TEVAR后长期不良结局风险增加的患者。
There is a lack of evidence about the predictive role of serum cardiac troponin I (cTnI) on the long-term adverse outcomes of acute type B aortic dissection (aTBAD) patients after thoracic endovascular aortic repair (TEVAR). In this study, we identified whether cTnI was an independent risk factor of 5-year adverse outcomes for aTBAD patients after TEVAR. We reviewed consecutive aTBAD patients without previous heart disease who were admitted for TEVAR. The total study population was divided into the cTnI(+) group (≥0.03 ng/mL) and the cTnI(−) group (<0.03 ng/mL) according to the time-dependent receiver operating characteristic curve analysis. The differences in clinical characteristics, operative details and clinical outcomes were compared between the two groups. There was no difference in age and male prevalence between the two groups. Compared with the cTnI(−) group, the incidence of chronic kidney disease was higher in patients with cTnI ≥0.03 ng/mL. In addition, the cTnI(+) group presented with more frequent premature beats and non-myocardial-infarction ST-T segment changes. In terms of laboratory examinations, white blood cell counts, neutrophil counts, serum D-dimer and serum fibrin degradation products showed an increase in the cTnI(+) group, while lymphocyte and platelet counts showed a decrease in these patients. Patients with elevated cTnI suffered from increased risks of 5-year aortic-related adverse events (hazard ratio, HR = 1.822, 95% confidence interval, CI: 1.094–3.035; p = 0.021) and all-cause mortality (HR = 4.009, 95% CI: 2.175–7.388; p < 0.001). Among aTBAD patients without previous heart disease, preoperative elevated cTnI identified patients at an increased risk of long-term adverse outcomes after TEVAR.
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