High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality

被引：111

作者：

Devereaux, P. J. ^{[1
,2
,3
]}

Lamy, Andre ^{[1
,2
,3
]}

Chan, Matthew T., V ^{[7
]}

Allard, Rene, V ^{[4
]}

Lomivorotov, Vladimir V. ^{[9
,10
]}

Landoni, Giovanni ^{[12
,13
]}

Zheng, Hong ^{[8
]}

Paparella, Domenico ^{[14
,15
]}

McGillion, Michael H. ^{[1
,3
]}

Belley-Cote, Emilie P. ^{[1
,2
,3
]}

Parlow, Joel L. ^{[4
]}

Underwood, Malcolm J. ^{[7
]}

Wang, Chew Yin ^{[16
]}

Dvirnik, Nazari ^{[1
,2
]}

Abubakirov, Marat ^{[9
]}

Fominskiy, Evgeny ^{[12
]}

Choi, Stephen ^{[5
,6
]}

Fremes, Stephen ^{[5
,6
]}

Monaco, Fabrizio ^{[12
,13
]}

Urrutia, Gerard ^{[17
,18
]}

Maestre, Marialuz ^{[17
]}

Hajjar, Ludhmila A. ^{[19
]}

Hillis, Graham S. ^{[23
,24
]}

Mills, Nicholas L. ^{[25
]}

Margari, Vito ^{[15
]}

Mills, Joseph D. ^{[26
]}

Billing, J. Stephen ^{[27
]}

Methangkool, Emily ^{[28
]}

Polanczyk, Carisi A. ^{[20
,21
]}

Sant'Anna, Roberto ^{[22
]}

Shukevich, Dmitry ^{[11
]}

Conen, David ^{[1
,2
,3
]}

Kavsak, Peter A. ^{[1
,2
]}

McQueen, Matthew J. ^{[1
,3
]}

Brady, Katheryn ^{[3
]}

Spence, Jessica ^{[1
,3
]}

Le Manach, Yannick ^{[1
,2
,3
]}

Mian, Rajibul ^{[1
,3
]}

Lee, Shun Fu ^{[1
,3
]}

Bangdiwala, Shrikant, I ^{[1
,3
]}

Hussain, Sara ^{[1
]}

Borges, Flavia K. ^{[1
,2
,3
]}

Pettit, Shirley ^{[2
,3
]}

Vincent, Jessica ^{[2
,3
]}

Guyatt, Gordon H. ^{[1
]}

Yusuf, Salim ^{[1
,2
,3
]}

Alpert, Joseph S. ^{[29
]}

White, Harvey D. ^{[30
,31
]}

Whitlock, Richard P. ^{[1
,2
,3
]}

机构：

[1] McMaster Univ, Hamilton, ON, Canada

[2] Hamilton Hlth Sci, Hamilton, ON, Canada

[3] Populat Hlth Res Inst, Hamilton, ON, Canada

[4] Queens Univ, Kingston, ON, Canada

[5] Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada

[6] Univ Toronto, Toronto, ON, Canada

[7] Chinese Univ Hong Kong, Hong Kong, Peoples R China

[8] Xinjiang Med Univ, Affiliated Hosp 1, Urumqi, Peoples R China

[9] E Meshalkin Natl Med Res Ctr, Novosibirsk, Russia

[10] Novosibirsk Stare Univ, Novosibirsk, Russia

[11] Res Inst Complex Issues Cardiovasc Dis, Kemerovo, Russia

[12] IRCCS San Raffaele Sci Inst, Milan, Italy

[13] Univ Vita Salute San Raffaele, Milan, Italy

[14] Univ Foggia, Foggia, Italy

[15] Santa Maria Hosp GVM Care & Res, Bari, Italy

[16] Univ Malaya, Kuala Lumpur, Malaysia

[17] Hosp Santa Creu & Sant Pau, Barcelona, Spain

[18] Inst Invest Biomed St Pau CIBERESP, Barcelona, Spain

[19] Univ Sao Paulo, Fac Med, Hosp Clin, Inst Coracao, Sao Paulo, Brazil

[20] Hosp Moinhos Vento, Porto Alegre, RS, Brazil

[21] Hosp Clin Porto Alegre, Porto Alegre, RS, Brazil

[22] Inst Cardiol Rio Grande do Sul, Porto Alegre, RS, Brazil

[23] Royal Perth Hosp, Perth, WA, Australia

[24] Univ Western Australia, Perth, WA, Australia

[25] Univ Edinburgh, Edinburgh, Midlothian, Scotland

[26] Liverpool Heart & Chest Hosp NHS Fdn Trust, Liverpool, Merseyside, England

[27] Royal Wolverhampton NHS Trust, Wolverhampton, England

[28] Univ Calif Los Angeles, Los Angeles, CA USA

[29] Univ Arizona, Coll Med, Tucson, AZ USA

[30] Auckland City Hosp, Auckland, New Zealand

[31] Univ Auckland, Auckland, New Zealand

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2022年 / 386卷 / 09期

基金：

加拿大健康研究院;

关键词：

HEART-DISEASE; SURVIVAL; ASSOCIATION; EVENTS; UPDATE;

D O I：

10.1056/NEJMoa2000803

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to >= 70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury. (Funded by the Canadian Institutes of Health Research and others; VISION Cardiac Surgery ClinicalTrials.gov number, NCT01842568.)

引用

页码：827 / 836

页数：10

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