Abstract：
Cardiac troponin I and T are both used for diagnosing myocardial infarction (MI) after coronary artery bypass grafting (CABG), also known as type 5 MI (MI-5). Different MI-5 definitions have been formulated, using multiples of the 99th percentile upper reference limit (10×, 35×, or 70× URL), with or without supporting evidence. These definitions are arbitrarily chosen based on conventional assays and do not differentiate between troponin I and T. We therefore investigated the kinetics of high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) following CABG.
A systematic search was applied to MEDLINE and EMBASE databases including the search terms \"coronary artery bypass grafting\" AND \"high-sensitivity cardiac troponin.\" Studies reporting hs-cTnI or hs-cTnT on at least 2 different time points were included. Troponin concentrations were extracted and normalized to the assay-specific URL.
For hs-cTnI and hs-cTnT, 17 (n = 1661 patients) and 15 studies (n = 2646 patients) were included, respectively. Preoperative hs-cTnI was 6.1× URL (95% confidence intervals: 4.9-7.2) and hs-cTnT 1.2× URL (0.9-1.4). Mean peak was reached 6-8 h postoperatively (126× URL, 99-153 and 45× URL, 29-61, respectively). Subanalysis of hs-cTnI illustrated assay-specific peak heights and kinetics, while subanalysis of surgical strategies revealed 3-fold higher hs-cTnI than hs-cTnT for on-pump CABG and 5-fold for off-pump CABG.
Postoperative hs-cTnI and hs-cTnT following CABG surpass most current diagnostic cutoff values. hs-cTnI was almost 3-fold higher than hs-cTnT, and appeared to be highly dependent on the assay used and surgical strategy. There is a need for assay-specific hs-cTnI and hs-cTnT cutoff values for accurate, timely identification of MI-5.
A systematic search was applied to MEDLINE and EMBASE databases including the search terms \"coronary artery bypass grafting\" AND \"high-sensitivity cardiac troponin.\" Studies reporting hs-cTnI or hs-cTnT on at least 2 different time points were included. Troponin concentrations were extracted and normalized to the assay-specific URL.
For hs-cTnI and hs-cTnT, 17 (n = 1661 patients) and 15 studies (n = 2646 patients) were included, respectively. Preoperative hs-cTnI was 6.1× URL (95% confidence intervals: 4.9-7.2) and hs-cTnT 1.2× URL (0.9-1.4). Mean peak was reached 6-8 h postoperatively (126× URL, 99-153 and 45× URL, 29-61, respectively). Subanalysis of hs-cTnI illustrated assay-specific peak heights and kinetics, while subanalysis of surgical strategies revealed 3-fold higher hs-cTnI than hs-cTnT for on-pump CABG and 5-fold for off-pump CABG.
Postoperative hs-cTnI and hs-cTnT following CABG surpass most current diagnostic cutoff values. hs-cTnI was almost 3-fold higher than hs-cTnT, and appeared to be highly dependent on the assay used and surgical strategy. There is a need for assay-specific hs-cTnI and hs-cTnT cutoff values for accurate, timely identification of MI-5.
摘要：
心肌肌钙蛋白I和T均用于诊断冠状动脉旁路移植术（CABG）后的心肌梗死（MI），也称为5型MI（MI-5）。已经制定了不同的MI-5定义，使用第99百分位数参考上限的倍数(10倍，35×,或70×URL)，有或没有证据支持。这些定义是基于常规测定法任意选择的，并且不区分肌钙蛋白I和T。因此，我们研究了CABG后高灵敏度心肌肌钙蛋白I（hs-cTnI）和T（hs-cTnT）的动力学。
对MEDLINE和EMBASE数据库进行了系统检索，包括检索术语“冠状动脉旁路移植术”和“高敏心肌肌钙蛋白”。研究报告了至少2个不同时间点的hs-cTnI或hs-cTnT。提取肌钙蛋白浓度并标准化为测定特异性URL。
对于hs-cTnI和hs-cTnT，包括17项（n=1661例患者）和15项研究（n=2646例患者），分别。术前hs-cTnI为6.1×URL（95％置信区间：4.9-7.2），hs-cTnT为1.2×URL（0.9-1.4）。术后6-8小时达到平均峰值(126×URL，99-153和45×URL，分别为29-61）。hs-cTnI的亚分析说明了测定特定的峰高和动力学，而手术策略的亚分析显示，泵入式CABG的hs-cTnI比hs-cTnT高3倍，非泵入式CABG高5倍。
CABG术后hs-cTnI和hs-cTnT超过了目前大多数诊断临界值。hs-cTnI几乎比hs-cTnT高3倍，并且似乎高度依赖于所使用的分析和手术策略。需要测定特异性的hs-cTnI和hs-cTnT截止值，及时识别MI-5。
对MEDLINE和EMBASE数据库进行了系统检索，包括检索术语“冠状动脉旁路移植术”和“高敏心肌肌钙蛋白”。研究报告了至少2个不同时间点的hs-cTnI或hs-cTnT。提取肌钙蛋白浓度并标准化为测定特异性URL。
对于hs-cTnI和hs-cTnT，包括17项（n=1661例患者）和15项研究（n=2646例患者），分别。术前hs-cTnI为6.1×URL（95％置信区间：4.9-7.2），hs-cTnT为1.2×URL（0.9-1.4）。术后6-8小时达到平均峰值(126×URL，99-153和45×URL，分别为29-61）。hs-cTnI的亚分析说明了测定特定的峰高和动力学，而手术策略的亚分析显示，泵入式CABG的hs-cTnI比hs-cTnT高3倍，非泵入式CABG高5倍。
CABG术后hs-cTnI和hs-cTnT超过了目前大多数诊断临界值。hs-cTnI几乎比hs-cTnT高3倍，并且似乎高度依赖于所使用的分析和手术策略。需要测定特异性的hs-cTnI和hs-cTnT截止值，及时识别MI-5。
