心肌肌钙蛋白与预测术后心肌梗死的相关性

IF 0.2 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Manish Pangi, Satish Govindaiah, Vivekananda Siddaiah, Jedidaiah Samraaj
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引用次数: 0

摘要

引言:本研究的目的是评估在接受非体外循环冠状动脉搭桥术(OPCAB)移植物手术的患者中,使用早期肌钙蛋白(cTn)水平来识别术后心肌梗死(MI)的有效性,确定影响因素,并确定早期识别的最佳截止值。材料和方法:本前瞻性研究纳入了2018年1月至2020年1月在单一手术室接受OPCAB的患者。注意他们的术前和术中特点。在12小时收集cTn,并研究住院结果。结果:共有370名患者被纳入研究。根据MI的通用定义,11名患者(2.9%)通过其他标准确定了MI,但220名患者(60%)使用cTn一致截断值确定。这表明冠状动脉搭桥术相关MI的标记严重错误,需要重新计算以获得现实的截断值。发现用于识别术后MI的最佳截止水平在12小时为1.8 ng/ml,具有较高的阴性预测值以排除错误标记。使用cTn范围而不是单个截止值会更有帮助。导致术后cTn升高显著错误标记的因素是术前高水平和术中发现的继发于抽吸稳定器的医源性血肿、肌内靶血管的手术操作。结论:cTn水平受各种患者和手术因素的影响,需要使用更高的截止值进行测量以排除MI。发现某些OPCAB特有的因素是主要原因。它将有助于识别需要早期侵入性再干预或集中重症监护的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Relevance of Cardiac Troponin in Predicting Postoperative Myocardial Infarction
Introduction: The aim of this study was to assess the validity of using early cardiac troponin (cTn) levels for the identification of postoperative myocardial infarction (MI) in patients undergoing off-pump coronary artery bypass (OPCAB) graft surgery, identify influencing factors, and determine optimal cut-off values for early identification. Materials and Methods: Patients undergoing OPCAB by a single surgical unit from January 2018 to January 2020 were included in this prospective study. Their preoperative and intraoperative characteristics were noted. The cTn was collected at 12 h and the in-hospital outcome was studied. Results: A total of 370 patients were included in the study. Eleven patients had MI determined by other criteria (2.9%), but 220 patients (60%) were identified using cTn consensus cut-off value, as per the universal definition of MI. This indicated significant mislabelling of coronary artery bypass graft-related MI and need for the recalculation to have a realistic cut-off value. The optimal cut-off levels at for identifying postoperative MI was found to be 1.8 ng/ml at 12 h, with a higher negative predictive value to exclude mislabeling. Using a cTn range, rather than a single cut-off value, would be more helpful. The factors causing significant mislabeled elevation of postoperative cTn were found to be preoperative high levels and intraoperative findings of iatrogenic hematoma secondary to suction stabilizer, surgical maneuvers for intramyocardial target vessels. Conclusion: The cTn levels were affected by the various patient and operative factors and measurements using higher cut-offs were needed to rule out MI. Certain factors peculiar to OPCAB were found to be significantly responsible. It will help identify patients needing earlier invasive re-intervention or focused intensive care.
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来源期刊
Research in Cardiovascular Medicine
Research in Cardiovascular Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-
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审稿时长
17 weeks
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