期刊
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
卷 317, 期 16, 页码 1642-1651出版社
AMER MEDICAL ASSOC
DOI: 10.1001/jama.2017.4360
关键词
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资金
- Roche Diagnostics
- Canadian Institutes of Health Research
- Heart and Stroke Foundation of Ontario
- Academic Health Science Centres Alternative Funding Plan Innovation Fund Ontario
- Population Health Research Institute
- CLARITY Research Group
- McMaster University Department of Surgery Surgical Associates
- Hamilton Health Science New Investigator Fund
- Hamilton Health Sciences
- Ontario Ministry of Resource and Innovation
- Stryker Canada
- McMaster University, Department of Anesthesiology
- St Joseph's Healthcare, Department of Medicine
- Father Sean O'Sullivan Research Centre
- McMaster University Department of Medicine
- Roche Diagnostics Global Office
- Hamilton Health Sciences Summer Studentships
- McMaster University Department of Clinical Epidemiology and Biostatistics
- McMaster University, Division of Cardiology
- Canadian Network and Centre for Trials Internationally
- Winnipeg Health Sciences Foundation
- University of Manitoba Department of Surgery
- Diagnostic Services of Manitoba Research
- Manitoba Medical Services Foundation
- Manitoba Health Research Council
- University of Manitoba Faculty of Dentistry Operational Fund
- University of Manitoba Department of Anesthesia
- University Medical Group, Department of Surgery, University of Manitoba, Start-up Fund
- National Health and Medical Research Council Program
- Projeto Hospitais de Excelencia a Servico do SUS (PROADI-SUS) grant from the Brazilian Ministry of Health
- Hcor (Cardiac Hospital Sao Paulo-SP)
- National Council for Scientific and Technological Development (CNPq) grant from the Brazilian Ministry of Science and Technology
- Public Policy Research Fund [CUHK-4002-PPR-3]
- Research Grant Council, Hong Kong SAR
- General Research Fund, Research Grant Council, Hong Kong SAR [461412]
- Australian and New Zealand College of Anaesthetists [13/008]
- School of Nursing, Universidad Industrial de Santander
- Grupo de Cardiologia Preventiva, Universidad Autonoma de Bucaramanga
- Fundacion Cardioinfantil-Instituto de Cardiologia
- Alianza Diagnostica SA
- Universite Pierre et Marie Curie
- Departement d'anesthesie Reanimation
- Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris
- St John's Medical College and Research Institute
- Division of Clinical Research and Training
- University of Malaya [RG3O2-14AFR]
- University of Malaya, Penyelidikan Jangka Pendek
- Polish Ministry of Science and Higher Education [NN402083939]
- University of KwaZulu-Natal
- Instituto de Salud Carlos III
- Fundacio La Marato de TV3
- American Heart Association
- Covidien
- National Institute for Health Research
- National Institute for Health Research [RP_2014-04-022] Funding Source: researchfish
IMPORTANCE Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS). OBJECTIVE To determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality). DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement. Starting in October 2008, participants were recruited at 23 centers in 13 countries; follow-up finished in December 2013. EXPOSURES Patients had hsTnT measurements 6 to 12 hours after surgery and daily for 3 days; 40.4% had a preoperative hsTnT measurement. MAIN OUTCOMES AND MEASURES A modified Mazumdar approach (an iterative process) was used to determine if there were hsTnT thresholds associated with risk of death and had an adjusted hazard ratio (HR) of 3.0 or higher and a risk of 30-day mortality of 3% or higher. To determine potential diagnostic criteria for MINS, regression analyses ascertained if postoperative hsTnT elevations required an ischemic feature (eg, ischemic symptom or electrocardiography finding) to be associated with 30-day mortality. RESULTS Among 21 842 participants, the mean age was 63.1 (SD, 10.7) years and 49.1% were female. Death within 30 days after surgery occurred in 266 patients (1.2%; 95% CI, 1.1%-1.4%). Multivariable analysis demonstrated that compared with the reference group (peak hsTnT <5 ng/L), peak postoperative hsTnT levels of 20 to less than 65 ng/L, 65 to less than 1000 ng/L, and 1000 ng/L or higher had 30-day mortality rates of 3.0%(123/4049; 95% CI, 2.6%-3.6%), 9.1% (102/1118; 95% CI, 7.6%-11.0%), and 29.6%(16/54; 95% CI, 19.1%-42.8%), with corresponding adjusted HRs of 23.63 (95% CI, 10.32-54.09), 70.34 (95% CI, 30.60-161.71), and 227.01 (95% CI, 87.35-589.92), respectively. An absolute hsTnT change of 5 ng/L or higher was associated with an increased risk of 30-day mortality (adjusted HR, 4.69; 95% CI, 3.52-6.25). An elevated postoperative hsTnT (ie, 20 to <65 ng/L with an absolute change >= 5 ng/L or hsTnT >= 65 ng/L) without an ischemic feature was associated with 30-day mortality (adjusted HR, 3.20; 95% CI, 2.37-4.32). Among the 3904 patients (17.9%; 95% CI, 17.4%-18.4%) with MINS, 3633 (93.1%; 95% CI, 92.2%-93.8%) did not experience an ischemic symptom. CONCLUSIONS AND RELEVANCE Among patients undergoing noncardiac surgery, peak postoperative hsTnT during the first 3 days after surgery was significantly associated with 30-day mortality. Elevated postoperative hsTnT without an ischemic feature was also associated with 30-day mortality.
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