Simultaneous Measurement of Cardiac Troponin I, B-type Natriuretic Peptide, and C-reactive Protein for the Prediction of Long-term Cardiac Outcome after Cardiac Surgery

被引:28
作者
Fellahi, Jean-Luc [1 ]
Hanouz, Jean-Luc
Le Manach, Yannick
Gue, Xavier
Monier, Emmanuel
Guillou, Louis
Riou, Bruno [2 ]
机构
[1] Ctr Hosp Prive St Martin, Serv Anesthesie Reanimat, Dept Anesthesiol, F-14050 Caen 4, France
[2] Univ Paris 06, CHU Pitie Salpetriere, AP HP, Dept Emergency Med, Paris, France
关键词
ARTERY-BYPASS SURGERY; HEART-FAILURE; RISK STRATIFICATION; STATIN THERAPY; A-TYPE; MORTALITY; ASSOCIATION; DYSFUNCTION; UTILITY; EVENTS;
D O I
10.1097/ALN.0b013e3181a1f720
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Simultaneous assessment of cardiac troponin 1, B-type natriuretic peptide, and C-reactive protein has been found to provide unique prognostic information in acute coronary syndromes. The current study addressed the prognostic implication of a multiple-marker approach in cardiac surgery. Methods:: Two hundred twenty-four patients undergoing cardiac surgery were included and followed up within 12 months after surgery. Serial blood samples were drawn in all patients the day before surgery, at the end of surgery, and 6, 24, and 1.20 h after surgery. Major adverse cardiac events within 12 months after surgery were chosen as study endpoints and were defined as malignant ventricular arrhythmia, myocardial infarction, congestive heart failure, the need for myocardial re-vascularization, and/or death from cardiac cause. Predictive ability of each cardiac biomarker was assessed using logistic regression. Results: Accuracies of C-reactive protein, cardiac troponin I, and B-type natriuretic peptide, considered as continuous variables, to predict the occurrence of major adverse cardiac events were limited (area under receiver operating characteristic curve: 0.54 [0.47-0.60], P = 0.42; 0.62 [0-55-0.68], P = 0.01; and 0.68 [0.61-0.74], P < 0.001, respectively). When biomarkers were considered as 75% specificity dichotomized variables, elevated C-reactive protein (> 180 mg/l), cardiac troponin I (> 3.5 ng/ml), and B-type natriuretic peptide (> 880 pg/ml) were independent predictors of major adverse cardiac events (odds ratio: 2.14 [1-03-4.49], P = 0.043; 2.37 [1.25-5.64], P = 0.011; and 2.65 [1.16-4.85], P = 0.018, respectively) in a multivariate model including the European System for Cardiac Operative Risk Evaluation score. Conclusions: Simultaneous measurement of cardiac troponin I, B-type natriuretic peptide, and C-reactive protein improves the risk assessment of long-term adverse cardiac outcome after cardiac surgery.
引用
收藏
页码:250 / 257
页数:8
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