Effects of peak time of myocardial injury biomarkers on mid-term outcomes of patients undergoing OPCABG

BMC Cardiovascular Disorders

Fei Gao¹  Bo Hu²  Ban Liu³  Zhi Li⁴  Yu Shi⁵  Yangyang Zhang⁵  Xi Chen⁵  Mengwei Lv⁶  Yipeng Feng⁷  Xiaoqi Meng⁸ 

[1] Cardiovascular Department, Huaiyin Hospital of Huai’an City, Huai’an, China;Department of Cardiology, Shanghai East Hospital, School of Medicine,Tongji University, Shanghai, China;Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine,Tongji University, Shanghai, China;Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China;Department of Cardiovascular Surgery, Shanghai East Hospital, School of Medicine,Tongji University, 150 Jimo Road, 200120, Shanghai, China;Shanghai East Hospital of Clinical Medical College, Nanjing Medical University, Shanghai, China;Department of Cardiovascular Surgery, Shanghai East Hospital, School of Medicine,Tongji University, 150 Jimo Road, 200120, Shanghai, China;The First Clinical Medical College of Nanjing Medical University, Nanjing, China;The Second Clinical Medical College of Nanjing Medical University, Nanjing, China;

关键词: Myocardial injury biomarker;    Coronary artery bypass grafting;    Off pump;    Mid-term outcome;   

DOI  :  10.1186/s12872-021-02006-5

来源: Springer

【 摘 要 】

BackgroundWith the development of cardiac surgery techniques, myocardial injury is gradually reduced, but cannot be completely avoided. Myocardial injury biomarkers (MIBs) can quickly and specifically reflect the degree of myocardial injury. Due to various reasons, there is no consensus on the specific values of MIBs in evaluating postoperative prognosis. This retrospective study was aimed to investigate the impact of MIBs on the mid-term prognosis of patients undergoing off-pump coronary artery bypass grafting (OPCABG).MethodsTotally 564 patients undergoing OPCABG with normal courses were included. Cardiac troponin T (cTnT) and creatine kinase myocardial band (CK-MB) were assessed within 48 h before operation and at 6, 12, 24, 48, 72, 96 and 120 h after operation. Patients were grouped by peak values and peak time courses of MIBs. The profile of MIBs and clinical variables as well as their correlations with mid-term prognosis were analyzed by univariable and multivariable Cox regression models.ResultContinuous assessment showed that MIBs increased first (12 h after surgery) and then decreased. The peak cTnT and peak CK-MB occurred within 24 h after operation in 76.8% and 67.7% of the patients respectively. No significant correlation was found between CK-MB and mid-term mortality. Delayed cTnT peak (peak cTnT elevated after 24 h after operation) was correlated with lower creatinine clearance rate (69.36 ± 21.67 vs. 82.18 ± 25.17 ml/min/1.73 m2), body mass index (24.35 ± 2.58 vs. 25.27 ± 3.26 kg/m2), less arterial grafts (1.24 ± 0.77 vs. 1.45 ± 0.86), higher EuroSCORE II (2.22 ± 1.12 vs.1.72 ± 0.91) and mid-term mortality (26.5 vs.7.9%). Age (HR: 1.067, CI: 1.006–1.133), left ventricular ejection fraction (HR: 0.950, CI: 0.910–0.993), New York Heart Association score (HR: 1.839, CI: 1.159–2.917), total venous grafting (HR: 2.833, CI: 1.054–7.614) and cTnT peak occurrence within 24 h (HR: 0.362, CI: 0.196–0.668) were independent predictors of mid-term mortality.ConclusioncTnT is a better indicator than CK-MB. The peak value and peak occurrence of cTnT are related to mid-term mortality in patients undergoing OPCABG, and the peak phases have stronger predictive ability. Trial registration: Chinese Clinical Trial Registry, ChiCTR2000033850. Registered 14 June 2020, http://www.chictr.org.cn/edit.aspx?pid=55162&htm=4.

【 授权许可】

CC BY