本公眾號(hào)每天分享一篇最新一期Anesthesia & Analgesia等SCI雜志的摘要翻譯，敬請(qǐng)關(guān)注并提出寶貴意見
Improving Prediction of Postoperative Myocardial Infarction With High-Sensitivity Cardiac Troponin T and NT-proBNP
背景與目的
本研究旨在確定術(shù)前測(cè)量的高敏感性心肌肌鈣蛋白T（hs-cTnT）和N末端腦鈉肽（NT-proBNP）與標(biāo)準(zhǔn)風(fēng)險(xiǎn)指數(shù)相比是否改善了非心臟手術(shù)患者的心臟風(fēng)險(xiǎn)預(yù)測(cè)。
方 法
在這項(xiàng)輔助性試驗(yàn)研究中，包括了術(shù)前測(cè)量hs-cTnT和NT-proBNP的572名患者（n = 572）。 研究的結(jié)果是術(shù)后第3天術(shù)后心肌梗死（MI）發(fā)生率。如果hs-cTnT> 40ng / L，NT-proBNP> 300ng / L，則認(rèn)為是升高的。 又另外在接收機(jī)統(tǒng)計(jì)特性的基礎(chǔ)上研究了其他的截取值。 利用標(biāo)準(zhǔn)方法和凈重分類指數(shù)，將生物標(biāo)志物風(fēng)險(xiǎn)預(yù)測(cè)與李氏修訂的心臟風(fēng)險(xiǎn)指數(shù)（RCRI）進(jìn)行比較。
結(jié) 果
向RCRI添加hs-cTnT（> 14ng / L）和NT-proBNP（> 300ng / L）能顯著改善術(shù)后MI預(yù)測(cè)（事件率30/572 [5.2％]，受試者手術(shù)特征曲線面積從0.590增加到0.716，重新分類指數(shù)為0.66，[95％置信區(qū)間為0.32-0.99，P <0.001]）。與300ng / L相比，使用108ng / L作為NT-proBNP的認(rèn)定值則明顯提高了靈敏度，（0.87 vs 0.53）。 hs-cTnT的敏感性、特異性、陽性和陰性預(yù)測(cè)值分別為0.70,0.60,0.09和0.97，NT-proBNP的敏感性、特異性、陽性和陰性預(yù)測(cè)值分別為0.53,0.68,0.08和0.96。
結(jié) 論
將心臟生理標(biāo)志物hs-cTnT和NT-proBNP加入到RCRI中改善了非心臟手術(shù)后即刻不良事件預(yù)測(cè)。術(shù)前hs-cTnT和NT-proBNP的高陰性預(yù)測(cè)值可用于術(shù)后MI風(fēng)險(xiǎn)的“排除”檢查。
原始文獻(xiàn)摘要
Kopec M, Duma A, Helwani M A, et al. Improving Prediction of Postoperative Myocardial Infarction With High-Sensitivity Cardiac Troponin T and NT-proBNP[J]. Anesthesia & Analgesia, 2017, 124(2):398.
BACKGROUND: This study sought to determine whether preoperatively measured high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) improve cardiac risk prediction in patients undergoing major noncardiac surgery compared with the standard risk indices.
METHODS: In this ancillary study to the Vitamins in Nitrous Oxide trial, patients were included who had preoperative hs-cTnT and NT-proBNP measured (n = 572). Study outcome was the incidence of postoperative myocardial infarction (MI) within the first 3 postoperative days. hs-cTnT was considered elevated if >14 ng/L and NT-proBNP if >300 ng/L. Additional cutoff values were investigated on the basis of receiver operating characteristic statistics. Biomarker risk prediction was compared with Lee’s Revised Cardiac Risk Index (RCRI) with the use of standard methods and net reclassification index.
RESULTS: The addition of hs-cTnT (>14 ng/L) and NT-proBNP (>300 ng/L) to RCRI significantly improved the prediction of postoperative MI (event rate 30/572 [5.2%], Area under the receiver operating characteristic curve increased from 0.590 to 0.716 with a 0.66 net reclassification
index [95% confidence interval 0.32–0.99], P < .001). The use of 108 ng/L as a cutoff for NT-proBNP improved sensitivity compared with 300 ng/L (0.87 vs 0.53). Sensitivity, specificity, positive, and negative predictive value for hs-cTnT were 0.70, 0.60, 0.09, and 0.97 and for NT-proBNP were 0.53, 0.68, 0.08, and 0.96.
CONCLUSIONS: The addition of cardiac biomarkers hs-cTnT and NT-proBNP to RCRI improves the prediction of adverse cardiac events in the immediate postoperative period after major noncardiac surgery. The high negative predictive value of preoperative hs-cTnT and NT-proBNP suggest usefulness as a “rule-out” test to confirm low risk of postoperative MI. (Anesth Analg 2016;XXX:00–00)
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