NEJM:高灵敏度心肌肌钙蛋白I水平与心脏手术后30天死亡风险

2022-03-08 MedSci原创 MedSci原创

心脏手术后与30天内死亡风险增加相关的高敏感性肌钙蛋白I水平明显高于目前的临床定义。

在美国和欧洲,每年有超过100万的病人接受心脏手术。虽然心脏手术有可能提高病人的生活质量,延长生命,但其导致的并发症也不容忽视。心肌损伤是心脏手术后的常见并发症,通过心肌肌钙蛋白或肌酸激酶MB4浓度升高来判断,但与围手术期心肌损伤相关的心肌肌钙蛋白升高的阈值十分宽泛,从>参考上限10倍到≥70倍,且支持证据有限。近日研究人员考察了心脏手术患者术后高灵敏度心肌肌钙蛋白I水平与预后的关系。

本次研究为一项国际前瞻性队列研究,涉及18岁或以上接受心脏手术的患者。在术后3至12小时以及术后1、2和3天测试高灵敏度心肌肌钙蛋白I水平(目前临床上的参考上限为26ng/L)。通过Cox分析,考察肌钙蛋白峰值与30天死亡率之间的关系,并根据欧洲心脏手术风险评估系统II的评分进行调整(该系统基于18个变量,包括年龄和性别,估计心脏手术后的死亡风险)。

13862名患者中,仅296名(2.1%)在术后30天内死亡。在接受单独冠状动脉旁路移植术或主动脉瓣置换或修复的患者中,术后1天内测量的肌钙蛋白水平超过5670ng/L与30天内死亡的校正危险比大于1.00相关,是参考上限的218倍。在接受其他心脏手术的患者中,相应的肌钙蛋白阈值为12981ng/L,是参考上限的499倍。

术后高灵敏度心肌肌钙蛋白I水平与预后

研究发现,心脏手术后与30天内死亡风险增加相关的高敏感性肌钙蛋白I水平明显高于目前的临床定义。

原始出处:

P.J. Devereaux et al. High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality. N Engl J MedMarch 3, 2022.

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    2022-10-20 smlt2008
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