检测高敏感性心肌肌钙蛋白T和NT-proBNP改善术后心肌梗死的预测
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Improving Prediction of Postoperative Myocardial Infarction With High-Sensitivity Cardiac Troponin T and NT-proBNP
背景与目的
本研究旨在确定术前测量的高敏感性心肌肌钙蛋白T（hs-cTnT）和N末端脑钠肽（NT-proBNP）与标准风险指数相比是否改善了非心脏手术患者的心脏风险预测。
方 法
在这项辅助性试验研究中，包括了术前测量hs-cTnT和NT-proBNP的572名患者（n = 572）。 研究的结果是术后第3天术后心肌梗死（MI）发生率。如果hs-cTnT> 40ng / L，NT-proBNP> 300ng / L，则认为是升高的。 又另外在接收机统计特性的基础上研究了其他的截取值。 利用标准方法和净重分类指数，将生物标志物风险预测与李氏修订的心脏风险指数（RCRI）进行比较。
结 果
向RCRI添加hs-cTnT（> 14ng / L）和NT-proBNP（> 300ng / L）能显著改善术后MI预测（事件率30/572 [5.2％]，受试者手术特征曲线面积从0.590增加到0.716，重新分类指数为0.66，[95％置信区间为0.32-0.99，P <0.001]）。与300ng / L相比，使用108ng / L作为NT-proBNP的认定值则明显提高了灵敏度，（0.87 vs 0.53）。 hs-cTnT的敏感性、特异性、阳性和阴性预测值分别为0.70,0.60,0.09和0.97，NT-proBNP的敏感性、特异性、阳性和阴性预测值分别为0.53,0.68,0.08和0.96。
结 论
将心脏生理标志物hs-cTnT和NT-proBNP加入到RCRI中改善了非心脏手术后即刻不良事件预测。术前hs-cTnT和NT-proBNP的高阴性预测值可用于术后MI风险的“排除”检查。
原始文献摘要
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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