Prognostic Value of Troponin and Creatine Kinase Muscle and Brain Isoenzyme Measurement after Noncardiac Surgery A Systematic Review and Meta-analysis

被引：163

作者：

Levy, Michael ^{[3
]}

Heels-Ansdell, Diane ^{[4
]}

Hiralal, Rajesh ^{[3
]}

Bhandari, Mohit ^{[4
,5
]}

Guyatt, Gordon ^{[3
,4
]}

Yusuf, Salim ^{[2
,3
,4
]}

Cook, Deborah ^{[3
,4
]}

Carlos Villar, Juan ^{[6
,7
]}

McQueen, Matthew ^{[8
,9
,10
]}

McFalls, Edward ^{[11
]}

Filipovic, Miodrag ^{[12
,13
]}

Schuenemann, Holger ^{[3
,4
]}

Sear, John ^{[14
]}

Foex, Pierre ^{[14
]}

Lim, Wendy ^{[3
]}

Landesberg, Giora ^{[15
]}

Godet, Gilles ^{[16
,17
]}

Poldermans, Don ^{[18
]}

Bursi, Francesca ^{[19
]}

Kertai, Miklos D. ^{[20
]}

Bhatnagar, Neera ^{[21
]}

Devereaux, P. J. ^{[1
,2
]}

机构：

[1] McMaster Univ, Hlth Sci Ctr, Dept Med & Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada

[2] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON L8N 3Z5, Canada

[3] McMaster Univ, Dept Med, Hamilton, ON L8N 3Z5, Canada

[4] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada

[5] McMaster Univ, Dept Surg, Hamilton, ON L8N 3Z5, Canada

[6] Univ Autonoma Bucaramanga, Grp Cardiol Prevent, Bogota, Colombia

[7] Fdn Cardioinfantil, Inst Cardiol, Dept Res, Bogota, Colombia

[8] McMaster Univ, Dept Pathol & Mol Med, Hamilton, ON L8N 3Z5, Canada

[9] Hamilton Hlth Sci, Hamilton Reg Lab Med Program, Hamilton, ON, Canada

[10] St Josephs Healthcare, Hamilton, ON, Canada

[11] Univ Minnesota, Dept Med, Vet Affairs Med Ctr, Minneapolis, MN 55455 USA

[12] Univ Basel Hosp, Dept Anaesthesia, CH-4031 Basel, Switzerland

[13] Kantonsspital Steet Gallen, Inst Anaesthesiol, Steet Gallen, Switzerland

[14] Univ Oxford, Nuffield Dept Anaesthet, Oxford, England

[15] Hebrew Univ Hadassah Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel

[16] Pontchaillou Hosp, Dept Anesthesiol, Rennes, France

[17] Pontchaillou Hosp, Dept Intens Care, Rennes, France

[18] Erasmus MC, Dept Anesthesiol, Rotterdam, Netherlands

[19] Policlin Univ Hosp, Cardiol Inst, Modena, Italy

[20] Duke Univ, Med Ctr, Dept Anesthesiol, Durham, NC 27710 USA

[21] McMaster Univ, Dept Lib Sci, Hamilton, ON L8N 3Z5, Canada

来源：

ANESTHESIOLOGY | 2011年 / 114卷 / 04期

关键词：

PERIOPERATIVE MYOCARDIAL-INFARCTION; CORONARY-CARE UNIT; CARDIAC TROPONIN; VASCULAR-SURGERY; ELDERLY-PATIENTS; RISK; PREDICTORS; EVENTS; MORTALITY; ISCHEMIA;

D O I：

10.1097/ALN.0b013e31820ad503

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Background: There is uncertainty regarding the prognostic value of troponin and creatine kinase muscle and brain isoenzyme measurements after noncardiac surgery. Methods: The current study undertook a systematic review and meta-analysis. The study used six search strategies and included noncardiac surgery studies that provided data from a multivariable analysis assessing whether a postoperative troponin or creatine kinase muscle and brain isoenzyme measurement was an independent predictor of mortality or a major cardiovascular event. Independent investigators determined study eligibility and abstracted data in duplicate. Results: Fourteen studies, enrolling 3,318 patients and 459 deaths, demonstrated that an increased troponin measurement after surgery was an independent predictor of mortality (odds ratio [OR] 3.4, 95% confidence interval [CI] 2.2-5.2), but there was substantial heterogeneity (I-2 = 56%). The independent prognostic capabilities of an increased troponin value after surgery in the 10 studies that assessed intermediate-term (<= 12 months) mortality was an OR = 6.7 (95% CI 4.1-10.9, I-2 = 0%) and in the 4 studies that assessed long-term (more than 12 months) mortality was an OR = 1.8 (95% CI 1.4-2.3, I-2 = 0%; P < 0.001 for test of interaction). Four studies, including 1,165 patients and 202 deaths, demonstrated an independent association between an increased creatine kinase muscle and brain isoenzyme measurement after surgery and mortality (OR 2.5, 95% CI 1.5-4.0, I-2 = 4%). Conclusions: An increased troponin measurement after surgery is an independent predictor of mortality, particularly within the first year; limited data suggest an increased creatine kinase muscle and brain isoenzyme measurement also predicts subsequent mortality. Monitoring troponin measurements after noncardiac surgery may allow physicians to better risk stratify and manage their patients.

引用

页码：796 / 806

页数：11

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