Jurlander B, Farhi E R, Banas J J, Keany C M, Balu D, Grande P, Ellis A K
Medical, Pathology and Laboratory Medicine, Department of Veterans Affairs Medical Center, Buffalo, New York, USA.
Am J Cardiol. 2000 Apr 1;85(7):810-4. doi: 10.1016/s0002-9149(99)00872-3.
This study sought to identify differences in coronary anatomic pathology in patients with unstable angina and elevated versus nonelevated serum troponin T values. Previous studies have shown a worse prognosis in unstable angina patients with elevated serum troponin T values. Consecutive patients (n = 117) with Braunwald class IIIB angina were included in the study. Serum samples for troponin T were obtained at admission and every 6 to 8 hours for 18 to 24 hours. Acute myocardial infarction was excluded by routine creatine kinase measurements. All patients underwent coronary angiography before discharge. Cardiac events including cardiac death and myocardial infarction were recorded. Two thirds of the patients with unstable angina had no increase in serum troponin T (<0.1 microg/L) (n = 80). They had a lower incidence of 3-vessel disease (26% vs 46%, p <0.001), left main disease (5% vs 16%, p = 0.04), visible thrombus (4% vs 22%, p = 0.006), and less severe stenosis of the culprit artery (65% vs 84%, p <0.004) than patients with elevated serum troponin T values (> or =0.1 microg/L) (n = 37). The 1-year cardiac event rate was 0% versus 19% in patients with troponin T values <0.1 microg/L compared with patients with serum troponin T values > or =0.1 microg/L (p <0.0001). It was concluded that patients with unstable angina and no release of troponin T have less severe coronary artery disease, and have an excellent prognosis. It is suggested that these patients may be managed more conservatively and without invasive evaluation before discharge.
本研究旨在确定不稳定型心绞痛患者中，血清肌钙蛋白T值升高与未升高者在冠状动脉解剖病理学上的差异。既往研究表明，血清肌钙蛋白T值升高的不稳定型心绞痛患者预后较差。本研究纳入了连续的117例Braunwald IIIB级心绞痛患者。入院时采集肌钙蛋白T血清样本，此后18至24小时内每6至8小时采集一次。通过常规肌酸激酶测量排除急性心肌梗死。所有患者在出院前均接受冠状动脉造影。记录包括心源性死亡和心肌梗死在内的心脏事件。三分之二的不稳定型心绞痛患者血清肌钙蛋白T未升高（<0.1μg/L）（n = 80）。与血清肌钙蛋白T值升高（≥0.1μg/L）的患者（n = 37）相比，他们三支血管病变的发生率较低（26%对46%，p <0.001），左主干病变较少（5%对16%，p = 0.04），可见血栓较少（4%对22%，p = 0.006），罪犯血管狭窄程度较轻（65%对84%，p <0.004）。肌钙蛋白T值<0.1μg/L的患者1年心脏事件发生率为0%，而血清肌钙蛋白T值≥0.1μg/L的患者为19%（p <0.0001）。结论是，不稳定型心绞痛且肌钙蛋白T未释放的患者冠状动脉疾病较轻，预后良好。建议对这些患者在出院前可采取更保守的管理方式，无需进行侵入性评估。
