摘要
背景:心脏外科手术可能伴随围手术期及术后的高发病率和死亡率。基础的病理学、外科技术及术后并发症均可影响预后。这些因素可能反映为术后肌钙蛋白水平升高。
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 μg/L, 95%confidence interval [CI] 1.05 to 1.24, P=0.002), 1 year (OR 1.10 per 10 μg/L, 95%CI 1.03 to 1.18, P=0.006) , and 3 years (OR 1.07 per 10 μg/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.
