冠状动脉搭桥手术后不同性别的肌钙蛋白和肌酸激酶阈值。

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2025-01-01 DOI:10.1016/j.athoracsur.2024.06.019

Leo Pölzl MD, PhD , Matthias Thielmann MD , Philipp Sterzinger MSc , Felix Nägele MD , Jakob Hirsch MD , Michael Graber MD, PhD , Clemens Engler MD , Jonas Eder , Ronja Lohmann , Sophia Schmidt , Simon Staggl MD , Samuel Heuts MD , Hanno Ulmer PhD , Michael Grimm MD , Elfriede Ruttmann-Ulmer MD , Nikolaos Bonaros MD , Johannes Holfeld MD , Can Gollmann-Tepeköylü MD, PhD

{"title":"冠状动脉搭桥手术后不同性别的肌钙蛋白和肌酸激酶阈值。","authors":"Leo Pölzl MD, PhD , Matthias Thielmann MD , Philipp Sterzinger MSc , Felix Nägele MD , Jakob Hirsch MD , Michael Graber MD, PhD , Clemens Engler MD , Jonas Eder , Ronja Lohmann , Sophia Schmidt , Simon Staggl MD , Samuel Heuts MD , Hanno Ulmer PhD , Michael Grimm MD , Elfriede Ruttmann-Ulmer MD , Nikolaos Bonaros MD , Johannes Holfeld MD , Can Gollmann-Tepeköylü MD, PhD","doi":"10.1016/j.athoracsur.2024.06.019","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The impact of sex-differences on the release of cardiac biomarkers after coronary artery bypass grafting (CABG) remains unknown. The aim of our study was to (1) investigate the impact of sex-differences in cardiac biomarker release after CABG and (2) determine sex-specific thresholds for high-sensitivity cardiac troponin (hs-cTn) and creatine kinase-myocardial band (CK-MB) associated with 30-day major adverse cardiovascular events (MACE) and mortality.</div></div><div><h3>Methods</h3><div>A consecutive cohort of 3687 patients, comprising 643 women (17.4%) and 3044 men (82.6%), undergoing CABG from 2008 to 2021 in 2 tertiary university centers with serial postoperative cTn and CK-MB measurement was analyzed. The composite primary outcome was MACE at 30 days. Secondary end points were 30-day mortality and 5-year mortality and MACE. Sex-specific thresholds for cTn and CK-MB were determined.</div></div><div><h3>Results</h3><div>Lower levels of cTn were found in women after CABG (69.18 vs 77.57 times the upper reference limit [URL]; <em>P</em> < .001). The optimal threshold value for cTn was calculated at 94.36 times the URL for female patients and 206.07 times the URL for male patients to predict 30-day MACE. Female patients missed by a general threshold had increased risk for MACE or death within 30 days (cTn: MACE: odds ratio [OR], 3.78; 95% CI, 1.03-13.08; <em>P</em> = .035; death: OR, 4.98; 95% CI, 1.20-20.61; <em>P</em> = .027; CK-MB: MACE: OR, 10.04; 95% CI, 2.07-48.75; <em>P</em> < .001; death: OR 13.59; 95% CI, 2.66-69.47; <em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>We provide evidence for sex-specific differences in the outcome and biomarker release after CABG. Sex-specific cutoffs are necessary for the diagnosis of perioperative myocardial injury to improve outcomes of women after CABG.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 1","pages":"Pages 120-128"},"PeriodicalIF":3.6000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Sex-Specific Troponin and Creatine Kinase Thresholds After Coronary Bypass Surgery\",\"authors\":\"Leo Pölzl MD, PhD , Matthias Thielmann MD , Philipp Sterzinger MSc , Felix Nägele MD , Jakob Hirsch MD , Michael Graber MD, PhD , Clemens Engler MD , Jonas Eder , Ronja Lohmann , Sophia Schmidt , Simon Staggl MD , Samuel Heuts MD , Hanno Ulmer PhD , Michael Grimm MD , Elfriede Ruttmann-Ulmer MD , Nikolaos Bonaros MD , Johannes Holfeld MD , Can Gollmann-Tepeköylü MD, PhD\",\"doi\":\"10.1016/j.athoracsur.2024.06.019\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The impact of sex-differences on the release of cardiac biomarkers after coronary artery bypass grafting (CABG) remains unknown. The aim of our study was to (1) investigate the impact of sex-differences in cardiac biomarker release after CABG and (2) determine sex-specific thresholds for high-sensitivity cardiac troponin (hs-cTn) and creatine kinase-myocardial band (CK-MB) associated with 30-day major adverse cardiovascular events (MACE) and mortality.</div></div><div><h3>Methods</h3><div>A consecutive cohort of 3687 patients, comprising 643 women (17.4%) and 3044 men (82.6%), undergoing CABG from 2008 to 2021 in 2 tertiary university centers with serial postoperative cTn and CK-MB measurement was analyzed. The composite primary outcome was MACE at 30 days. Secondary end points were 30-day mortality and 5-year mortality and MACE. Sex-specific thresholds for cTn and CK-MB were determined.</div></div><div><h3>Results</h3><div>Lower levels of cTn were found in women after CABG (69.18 vs 77.57 times the upper reference limit [URL]; <em>P</em> < .001). The optimal threshold value for cTn was calculated at 94.36 times the URL for female patients and 206.07 times the URL for male patients to predict 30-day MACE. Female patients missed by a general threshold had increased risk for MACE or death within 30 days (cTn: MACE: odds ratio [OR], 3.78; 95% CI, 1.03-13.08; <em>P</em> = .035; death: OR, 4.98; 95% CI, 1.20-20.61; <em>P</em> = .027; CK-MB: MACE: OR, 10.04; 95% CI, 2.07-48.75; <em>P</em> < .001; death: OR 13.59; 95% CI, 2.66-69.47; <em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>We provide evidence for sex-specific differences in the outcome and biomarker release after CABG. Sex-specific cutoffs are necessary for the diagnosis of perioperative myocardial injury to improve outcomes of women after CABG.</div></div>\",\"PeriodicalId\":50976,\"journal\":{\"name\":\"Annals of Thoracic Surgery\",\"volume\":\"119 1\",\"pages\":\"Pages 120-128\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Thoracic Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0003497524005381\",\"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":"Annals of Thoracic Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0003497524005381","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

摘要

背景：冠状动脉旁路移植术（CABG）后，性别差异对心脏生物标志物释放的影响尚不清楚。我们的研究旨在：(a) 调查冠状动脉旁路移植术后性别差异对心脏生物标志物释放的影响；(b) 确定与 30 天主要不良心血管事件（MACE）和死亡率相关的高敏肌钙蛋白（hs-cTn）和肌酸激酶-MB（CK-MB）的性别特异性阈值：分析了2008-2021年期间在两所三级大学中心接受CABG手术的3687名连续队列患者（女性：643人（17.4%）；男性：3044人（82.6%）），这些患者术后均接受了连续的cTn和CK-MB测量。复合主要结局是 30 天内的 MACE。次要终点为 30 天死亡率、五年死亡率和 MACE。确定了cTn和CK-MB的性别特异性阈值：结果：CABG术后女性的cTn水平较低（69.18 xURL vs. 77.57 xURL; p结论：我们提供了性别差异对CABG术后女性cTn水平影响的证据：我们提供的证据表明，CABG术后的结果和生物标志物的释放存在性别差异。有必要为围术期心肌损伤的诊断设定特定性别的临界值，以改善女性接受 CABG 术后的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Sex-Specific Troponin and Creatine Kinase Thresholds After Coronary Bypass Surgery

Background

The impact of sex-differences on the release of cardiac biomarkers after coronary artery bypass grafting (CABG) remains unknown. The aim of our study was to (1) investigate the impact of sex-differences in cardiac biomarker release after CABG and (2) determine sex-specific thresholds for high-sensitivity cardiac troponin (hs-cTn) and creatine kinase-myocardial band (CK-MB) associated with 30-day major adverse cardiovascular events (MACE) and mortality.

Methods

A consecutive cohort of 3687 patients, comprising 643 women (17.4%) and 3044 men (82.6%), undergoing CABG from 2008 to 2021 in 2 tertiary university centers with serial postoperative cTn and CK-MB measurement was analyzed. The composite primary outcome was MACE at 30 days. Secondary end points were 30-day mortality and 5-year mortality and MACE. Sex-specific thresholds for cTn and CK-MB were determined.

Results

Lower levels of cTn were found in women after CABG (69.18 vs 77.57 times the upper reference limit [URL]; P < .001). The optimal threshold value for cTn was calculated at 94.36 times the URL for female patients and 206.07 times the URL for male patients to predict 30-day MACE. Female patients missed by a general threshold had increased risk for MACE or death within 30 days (cTn: MACE: odds ratio [OR], 3.78; 95% CI, 1.03-13.08; P = .035; death: OR, 4.98; 95% CI, 1.20-20.61; P = .027; CK-MB: MACE: OR, 10.04; 95% CI, 2.07-48.75; P < .001; death: OR 13.59; 95% CI, 2.66-69.47; P = .002).

Conclusions

We provide evidence for sex-specific differences in the outcome and biomarker release after CABG. Sex-specific cutoffs are necessary for the diagnosis of perioperative myocardial injury to improve outcomes of women after CABG.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.