Circulation：非心脏术后心肌损伤预测30天死亡率

　　荷兰一项研究表明，术后心肌损伤为非心脏手术后30天死亡率的独立预测因子；肌钙蛋白监测有助于改善非心脏手术患者预后。论文于5月10日在线发表于《循环》（Circulation）。

　　此项观察性单中心队列研究共纳入2232例中、高危非心脏手术患者（年龄≥60岁）。在术后三天内测定肌钙蛋白。评估术后心肌损伤（肌钙蛋白I水平>0.06 mcg/L）与30天全因死亡率的相关性。

　　结果显示，共有315例（19%）患者出现心肌损伤。56例（3%）患者发生全因死亡。肌钙蛋白轻度升高（0.07～0.59 mcg/L）的相对危险度为2.4，肌钙蛋白升高10至100倍（≥0.60mcg/L）的相对危险度为4.2。依据通用定义，10例（0.6%）患者被诊断为心肌梗死，其中1例为ST段抬高型心肌梗死。

Myocardial Injury after Noncardiac Surgery and its Association with Short-Term Mortality.
BACKGROUND
To identify patients at risk for postoperative myocardial injury and death, it has been suggested to measure cardiac troponin routinely after noncardiac surgery. Such monitoring was implemented in our hospital. The aim of this study was to determine the predictive value of postoperative myocardial injury, as measured by troponin elevation, on 30 day mortality after noncardiac surgery.
METHODS AND RESULTS
This observational single center cohort study included 2,232 consecutive intermediate to high risk noncardiac surgery patients aged 60 and above operated in 2011. Troponin was measured on the first three postoperative days. Log binomial regression analysis was used to estimate the association between postoperative myocardial injury (troponin I level >0.06 mcg/L) and all-cause 30-day mortality. Myocardial injury was found in 315 (19%) patients. All-cause death occurred in 56 (3%) patients. The relative risk of a minor increase in troponin (0.07-0.59 mcg/L) was 2.4 (95% CI 1.3-4.2, p<0.01), and the relative risk of a 10-100 fold increase in troponin (≥0.60mcg/L) was 4.2 (95% CI 2.1-8.6, p<0.01). A myocardial infarction according to the universal definition was diagnosed in 10 patients (0.6%), of which one (0.06%) had ST-elevation myocardial infarction.
CONCLUSIONS
Postoperative myocardial injury is an independent predictor of 30-day mortality after noncardiac surgery. Implementation of postoperative troponin monitoring as standard of care is feasible and might be helpful to improve the prognosis of patients undergoing noncardiac surgery.