Relationship between postoperative cardiac troponin I levels and outcome of cardiac surgery
Relationship between postoperative cardiac troponin I levels and outcome of cardiac surgery
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DOI：
10.1161/circulationaha.105.602370
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发表时间：
2006-10-03
期刊：
影响因子：
37.8
通讯作者：
Cuthbertson, Brian H.
中科院分区：
文献类型：
--
作者：
Croal, Bernard L.;Hillis, Graham S.;Cuthbertson, Brian H.
背景：心脏手术可能与围手术期和术后显著的发病率和死亡率相关。基础病理、手术技术和术后并发症都可能影响结果。这些因素可能反映为术后肌钙蛋白水平的升高。因此，对这种情况下肌钙蛋白水平的解释可能是复杂的。考虑到潜在的混杂变量，本研究评估了这些测量的预后意义。方法与结果：1365例接受心脏手术的患者在术后2小时和24小时测量心肌肌钙蛋白I （cTnI）。这些测量结果与随后的死亡率之间的关系已经确立。在考虑了所有其他变量后，24小时测量的cTnI水平可独立预测30天的死亡率（比值比[OR] 1.14 / 10 μ g/L， 95%置信区间[CI] 1.05 ~ 1.24， P=0.002）、1年（OR 1.10 / 10 μ g/L, 95% CI 1.03 ~ 1.18， P=0.006）和3年（OR 1.07 / 10 μ g/L, 95% CI 1.00 ~ 1.15， P=0.04）。24小时内最高四分位数的心脏TnI水平与特别差的预后相关。结论：心脏手术后24小时测量的ctni水平可以预测短期、中期和长期死亡率，并且在校正所有其他潜在的混杂变量（包括手术复杂性）后仍然具有独立的预测能力。
Background-Cardiac surgery may be associated with significant perioperative and postoperative morbidity and mortality. Underlying pathology, surgical technique, and postoperative complications may all influence outcome. These factors may be reflected as a rise in postoperative troponin levels. Interpretation of troponin levels in this setting may therefore be complex. This study assessed the prognostic significance of such measurements, taking into account potential confounding variables.Methods and Results-One-thousand three hundred sixty-five patients undergoing cardiac surgery underwent measurement of cardiac troponin I (cTnI) at 2 and 24 hours after surgery. The relationship of these measurements to subsequent mortality was established. After taking into account all other variables, cTnI levels measured at 24 hours were independently predictive of mortality at 30 days (odds ratio [OR] 1.14 per 10 mu g/L, 95% confidence interval [CI] 1.05 to 1.24, P=0.002), 1 year (OR 1.10 per 10 mu g/L, 95% CI 1.03 to 1.18, P=0.006), and 3 years (OR 1.07 per 10 mu g/L, 95% CI 1.00 to 1.15, P=0.04). Cardiac TnI levels in the highest quartile at 24 hours were associated with a particularly poor outcome.Conclusions-cTnI levels measured 24 hours after cardiac surgery predict short-, medium-, and long-term mortality and remain independently predictive when adjusted for all other potentially confounding variables, including operation complexity.