{"title":"冠状动脉旁路移植术后高敏心肌肌钙蛋白 I 升高对长期预后的影响","authors":"Juncheng Wang, Peng Wang, Hanning Liu, Yan Zhao, Wei Feng, Sheng Liu, Zhe Zheng","doi":"10.1016/j.cjca.2024.10.018","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Postoperative myocardial injury is correlated with long-term prognosis after coronary artery bypass grafting (CABG) and is diagnosed with troponin levels, which vary substantially upon surgical strategies. We aimed to explore the troponin I cut-off values for prognostically significant myocardial injury separately in on-pump and off-pump procedures with a high-sensitivity assay (hs-cTnI).</p><p><strong>Methods: </strong>Patients who underwent isolated CABG from 2018 to 2020 with available perioperative hs-cTnI measurements were included in the current study and followed up. We explored the relationships between hs-cTnI levels and different outcomes. To identify hs-cTnI threshold levels indicative of higher risks, restrictive spline regressions were performed for on-pump and off-pump procedures.</p><p><strong>Results: </strong>A total of 7813 patients were included with a median follow-up of 2.7 years (interquartile range [IQR]: 1.7-3.3 years) years, 218 (2.8%) of whom experienced death. Upon adjusting for clinical variables, the study found a significant association between peak hs-cTnI levels within the first 48 hours after surgery and all endpoints. The spline regressions demonstrated that the hs-cTnI levels measured within 48 hours after surgery, which were associated with a hazard ratio of more than 1.00 for all-cause death, were 1,446ng/L (55.6×upper reference limit [URL], 95% CI: 45.0-106.5) for on-pump and 564ng/L (21.7×URL, 95% CI: 21.0-30.2) for off-pump.</p><p><strong>Conclusions: </strong>Elevated hs-cTnI levels after CABG were associated with poorer longer-term outcomes. A prognosis relevant hs-cTnI cut-off value within 48 hours post-CABG for on-pump is significantly higher than that for off-pump.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":5.8000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of High-Sensitivity Cardiac Troponin I Elevation after On- and Off-pump Coronary Artery Bypass Grafting on Long-term Prognosis.\",\"authors\":\"Juncheng Wang, Peng Wang, Hanning Liu, Yan Zhao, Wei Feng, Sheng Liu, Zhe Zheng\",\"doi\":\"10.1016/j.cjca.2024.10.018\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Postoperative myocardial injury is correlated with long-term prognosis after coronary artery bypass grafting (CABG) and is diagnosed with troponin levels, which vary substantially upon surgical strategies. We aimed to explore the troponin I cut-off values for prognostically significant myocardial injury separately in on-pump and off-pump procedures with a high-sensitivity assay (hs-cTnI).</p><p><strong>Methods: </strong>Patients who underwent isolated CABG from 2018 to 2020 with available perioperative hs-cTnI measurements were included in the current study and followed up. We explored the relationships between hs-cTnI levels and different outcomes. To identify hs-cTnI threshold levels indicative of higher risks, restrictive spline regressions were performed for on-pump and off-pump procedures.</p><p><strong>Results: </strong>A total of 7813 patients were included with a median follow-up of 2.7 years (interquartile range [IQR]: 1.7-3.3 years) years, 218 (2.8%) of whom experienced death. Upon adjusting for clinical variables, the study found a significant association between peak hs-cTnI levels within the first 48 hours after surgery and all endpoints. The spline regressions demonstrated that the hs-cTnI levels measured within 48 hours after surgery, which were associated with a hazard ratio of more than 1.00 for all-cause death, were 1,446ng/L (55.6×upper reference limit [URL], 95% CI: 45.0-106.5) for on-pump and 564ng/L (21.7×URL, 95% CI: 21.0-30.2) for off-pump.</p><p><strong>Conclusions: </strong>Elevated hs-cTnI levels after CABG were associated with poorer longer-term outcomes. A prognosis relevant hs-cTnI cut-off value within 48 hours post-CABG for on-pump is significantly higher than that for off-pump.</p>\",\"PeriodicalId\":9555,\"journal\":{\"name\":\"Canadian Journal of Cardiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.8000,\"publicationDate\":\"2024-10-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Canadian Journal of Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.cjca.2024.10.018\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cjca.2024.10.018","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Impact of High-Sensitivity Cardiac Troponin I Elevation after On- and Off-pump Coronary Artery Bypass Grafting on Long-term Prognosis.
Background: Postoperative myocardial injury is correlated with long-term prognosis after coronary artery bypass grafting (CABG) and is diagnosed with troponin levels, which vary substantially upon surgical strategies. We aimed to explore the troponin I cut-off values for prognostically significant myocardial injury separately in on-pump and off-pump procedures with a high-sensitivity assay (hs-cTnI).
Methods: Patients who underwent isolated CABG from 2018 to 2020 with available perioperative hs-cTnI measurements were included in the current study and followed up. We explored the relationships between hs-cTnI levels and different outcomes. To identify hs-cTnI threshold levels indicative of higher risks, restrictive spline regressions were performed for on-pump and off-pump procedures.
Results: A total of 7813 patients were included with a median follow-up of 2.7 years (interquartile range [IQR]: 1.7-3.3 years) years, 218 (2.8%) of whom experienced death. Upon adjusting for clinical variables, the study found a significant association between peak hs-cTnI levels within the first 48 hours after surgery and all endpoints. The spline regressions demonstrated that the hs-cTnI levels measured within 48 hours after surgery, which were associated with a hazard ratio of more than 1.00 for all-cause death, were 1,446ng/L (55.6×upper reference limit [URL], 95% CI: 45.0-106.5) for on-pump and 564ng/L (21.7×URL, 95% CI: 21.0-30.2) for off-pump.
Conclusions: Elevated hs-cTnI levels after CABG were associated with poorer longer-term outcomes. A prognosis relevant hs-cTnI cut-off value within 48 hours post-CABG for on-pump is significantly higher than that for off-pump.
期刊介绍:
The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.