期刊
ANNALS OF THORACIC SURGERY
卷 104, 期 4, 页码 1289-1297出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.athoracsur.2017.03.003
关键词
-
资金
- Swiss National Science Foundation
- Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, Basel University Hospital, Switzerland
Background. Elevated, single-measure, postoperative troponin is associated with adverse events after cardiac surgery. We hypothesized that increases in troponin from the first to the second postoperative day are also associated with all-cause, 12-month mortality and major adverse cardiac events (MACE). Methods. This observational study included consecutive adults undergoing on-pump cardiac surgery with cardiac arrest. Troponin T was measured on the first and second postoperative day and was classified as increasing (> 10%), unchanged (10% to -10%), or decreasing (<-10%). The primary endpoint was all-cause, 12-month mortality. Secondary endpoints were all-cause 12-month mortality or MACE and both outcomes at 30 days. The main analysis was by multivariable Cox regression. Results. Of 1,417 included patients, 99 (7.0%) died and 162 (11.4%) died or suffered MACE at 12 months. A significant interaction (p < 0.001) between first postoperative day troponin and the troponin trend from the first to the second postoperative day on 12-month, all-cause mortality precluded an analysis independent of first postoperative day troponin. Consequently, we stratified patients by their first postoperative day troponin (cutoff, 0.8 mg/L). Increasing troponin was associated with higher mortality in patients with first postoperative day troponin T >= 0.8 mg/L (hazard ratio, 1.98; 95% CI, 1.09 to 3.59; p = 0.025). Conclusions. Troponin changes from the first to the second postoperative day should not be interpreted without consideration of the first postoperative day troponin concentration. For patients with a first postoperative day troponin >= 0.8 mg/L, an increase by more than 10% from the first to the second postoperative day was significantly associated with all-cause, 12-month mortality and other adverse events. (C) 2017 by The Society of Thoracic Surgeons
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