在心脏手术期间使用高灵敏度的Troponin T来定义外科手术期间的心肌损伤
Vikram Sharma1, Huili Zheng2, Luciano Candilio3
1Department of Cardiovascular Medicine, University of Iowa, Iowa City, IA 52242, USA.
Journal of clinical medicine
|July 14, 2023
概括
心脏手术后高灵敏度托罗T (hs-TnT) 的升高表明死亡风险较高. 一个24小时的术后hs-TnT水平是指标上限的50倍,最能预测1年生存率.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 生物标志物 生物标志物
背景情况:
- 在心脏外科手术后使用高灵敏度热素 (hs-Tn) 切断界限来定义术前心肌损伤 (PMI) 仍然具有挑战性.
- 准确识别PMI对于患者的预后至关重要.
研究的目的:
- 评估心脏外科手术患者手术前高灵敏度托邦素T (hs-TnT) 升高与1年全因死亡率之间的关联.
- 为了确定可靠的hs-TnT预后显著的PMI的截止值.
主要方法:
- 一项涉及1206名患者的ERICCA试验的后期分析.
- 评估基线和各种手术后hs-TnT值 (测量在6,12,24,48,72小时) 的1年全因死亡率.
- 对基线hs-TnT和EuroSCORE进行统计调整.
主要成果:
- 基线hs-TnT升高>1x第99百分点URL与1年死亡率增加有关 (aHR为1.90).
- 在正常基线hs-TnT的患者中,观察到显著的死亡风险,手术后24小时后的URL升高≥50 × URL.
- 24小时后hs-TnT升高≥50×URL显示出最佳的灵敏度 (73%) 和特异性 (75%) 预测死亡率.
结论:
- 基线和术后hs-TnT升高都是心脏手术后1年全因死亡率的独立预测指标.
- 在手术后24小时,hs-TnT升高≥50×URL被认为是定义预后显著PMI的最佳值.
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