Key result
Elevated postoperative log10 CK-MB was an independent predictor of 30-day mortality (HR 4.64) in patients undergoing surgery for acute type A aortic dissection, though it did not predict long-term mortality.
Why the study?
Evidence regarding the prognostic ability of perioperative myocardial markers on long-term outcome in acute type A aortic dissection was limited.
Do perioperative myocardial markers predict short- and long-term mortality in surgical patients with type A aortic dissection?
Cohort (n=583)
No
Do perioperative myocardial markers predict short- and long-term mortality in surgical patients with type A aortic dissection?
Hazard Ratio: 4.64 (95% CI 1.89–11.43)
p-value: p=0.0008
Perioperative myocardial markers predict early (30-day) mortality but not long-term all-cause mortality in patients undergoing surgery for 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 long-term mortality.About one-fifth of patients has a positive preoperative myocardial markers, which was increased significantly after operation. Increase log10 post-creatine kinase MB isoenzyme (CK-MB) (hazard ratio [HR], 4.64; 95% confidence interval [CI] 1.89-11.43; P = .0008), log10 post-TnI (HR, 3.11; 95% CI 1.56-6.21; P = .0013), log10 post-Mb (HR, 3.00; 95% CI 1.40-6.43; P = .0048), log10 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.
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Gong et al. (2019) conducted a cohort in Stanford type A aortic dissection (n=583). Elevated perioperative myocardial biomarkers (CK-MB, hs-TnI, Mb) vs. Lower biomarker levels was evaluated on 30-day all-cause mortality (HR 4.64, 95% CI 1.89-11.43, p=0.0008). Elevated postoperative log10 CK-MB was an independent predictor of 30-day mortality (HR 4.64) in patients undergoing surgery for acute type A aortic dissection, though it did not predict long-term mortality.
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