Comparison of prognostic ability of perioperative myocardial biomarkers in acute type A aortic dissection
Stanford type A aortic dissection (AD) is a lethal disease requiring surgery. Evidence regarding the prognostic ability of perioperative myocardiac markers on long-term outcome is limited. In this cohort study, we measured perioperative myocardiac markers level in 583 surgical patients with type A AD in our hospital between 2015 and 2017. All patients were followed up after surgery for a median period of 864 days to determine short-and longterm mortality. About one-fifth of patients has a
... atients has a positive preoperative myocardial markers, which was increased significantly after operation. Increase log 10 post-creatine kinase MB isoenzyme (CK-MB) (hazard ratio [HR], 4.64; 95% confidence interval [CI] 1.89-11.43; P = .0008), log 10 post-TnI (HR, 3.11; 95% CI 1.56-6.21; P = .0013), log 10 post-Mb (HR, 3.00; 95% CI 1.40-6.43; P = .0048), log 10 pre-CK-MB (HR,1.82; 95% CI 1.03-3.21; P = .0377), and upper tertile of post-CK-MB (HR,1.52; 95% CI 1.05-2.20; P = .0261) were the independent risk factor for 30 days mortality adjusted for potential confounders. None of cardiac markers was significantly associated with long-term outcome independent of other factors. Perioperative myocardiac predicts early outcome in type A AD patients undergoing surgery. Increasing perioperative myocardial markers do not appear to be a predictor for long-term all-cause mortality. Abbreviations: AD = aortic dissection, CI = confidence interval, CK-MB = creatine kinase MB isoenzyme, CPB = cardiopulmonary bypass, HR = hazard ratio, hs-TnI = high sensitivity troponin I, LVEDD = left ventricular end diastolic diameter, Mb = myoglobin, ROC = receiver operating characteristic, UCG = ultrasound cardiogram, URL = upper reference limit.