Comparison of prognostic ability of perioperative myocardial biomarkers in acute type A aortic dissection

摘要

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 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.