- 作者：Victor Aboyans ; Sté ; phane Né ; gret ; Philippe Lacroix ; Elisabeth Cornu ; Marc Laskar
- 刊名：Archives of Cardiovascular Diseases Supplements
- 出版年：2011
- 出版时间：January 2011
- 年：2011
- 卷：3
- 期：1
- 页码：110
- 全文大小：58 K
Background
In the new (2007) universal definition for myocardial infarction (MI), the type-5 corresponded to MI after coronary revascularization, with cardiac enzymes release >5x normal values (N) required after coronary artery bypass graft (CABG) surgery. However, data on long-term prognosis of patients with post-operative troponin release are scarce.Methods
We followed up 826 consecutive patients operated for CABG between 1998 and 2002 in our institution. Post-operative troponin Ic (Tr-Ic) release has been systematically monitored. The primary outcome was total mortality. The secondary outcome was composite and combined: death, acute coronary syndrome, stroke, coronary or peripheral revascularization.
Results
Among the 693 men and 133 women (age 66.1 ¡À 9.3 yrs), post-operative Tr-Ic peak >5xN, >10xN and >20xN were at 54.8 % , 29.6 % and 15.6 % , respectively. During the follow-up period (6.5 ¡À 2.7 yrs), 146 (17.6 % ) deceased, and 302 (36.6 % ) met the composite outcome. Only the survival curves of those with Tr-Ic peak >10xN were significantly poorer than those without type-5 MI (Figure). Adjusted for age, sex, use of beta-blockers and statins, CVD risk factors, NYHA stage, LVEF <40 % , number of bypasses, on/off-pump surgery, atrial fibrillation, peripheral artery or chronic kidney disease, only Tr-Ic >20xN was associated with mortality, and Tr-Ic >10xN was predictive for the composite outcome (table).
Conclusions
| Mortality | Composite endpoint | |||
|---|---|---|---|---|
| Tr-Ic peak | HR (95 % CI) | p | HR (95 % CI) | p |
| < 5xN | ref | ref | ||
| 5 to <10 xN | 1.02 (0.65?.61) | ns | 1.14 (0.84?.55) | ns |
| 10 to <20 xN | 1.33 (0.78?.26) | ns | 1.45 (1.02?.07) | 0.04 |
| 20 xN | 1.81 (1.14?.88) | 0.01 | 1.38 (1.00?.94) | 0.05 |