Lindahl B, Toss H, Siegbahn A, Venge P, Wallentin L
Department of Cardiology, University of Uppsala, Sweden.
N Engl J Med. 2000 Oct 19;343(16):1139-47. doi: 10.1056/NEJM200010193431602.
In patients with unstable coronary artery disease, there is a relation between the short-term risk of death and blood levels of troponin T (a marker of myocardial damage) and C-reactive protein and fibrinogen (markers of inflammation). Using information obtained during an extension of the follow-up period in the Fragmin during Instability in Coronary Artery Disease trial, we evaluated the usefulness of troponin T, C-reactive protein, and fibrinogen levels and other indicators of risk as predictors of the long-term risk of death from cardiac causes.
Levels of C-reactive protein and fibrinogen at enrollment and the maximal level of troponin T during the first 24 hours after enrollment were analyzed in 917 patients included in a clinical trial of low-molecular-weight heparin in unstable coronary artery disease. The patients were followed for a mean of 37.0 months (range, 1.6 to 50.6).
During follow-up, 1.2 percent of the 173 patients with maximal blood troponin T levels of less than 0.06 microg per liter died of cardiac causes, as compared with 8.7 percent of the 367 patients with levels of 0.06 to 0.59 microg per liter and 15.4 percent of the 377 patients with levels of at least 0.60 microg per liter (P=0.007 and P=0.001, respectively). The rates of death from cardiac causes were 5.7 percent among the 314 patients with blood C-reactive protein levels of less than 2 mg per liter, 7.8 percent among the 294 with levels of 2 to 10 mg per liter, and 16.5 percent among the 309 with levels of more than 10 mg per liter (P=0.29 and P=0.001, respectively). The rates of death from cardiac causes were 5.4 percent among the 314 patients with blood fibrinogen levels of less than 3.4 g per liter, 12.0 percent among the 300 with levels of 3.4 to 3.9 g per liter, and 12.9 percent among the 303 with levels of at least 4.0 g per liter (P=0.004 and P=0.69, respectively). In a multivariate analysis, levels of troponin T and C-reactive protein were independent predictors of the risk of death from cardiac causes.
In unstable coronary artery disease, elevated levels of troponin T and C-reactive protein are strongly related to the long-term risk of death from cardiac causes. These markers are independent risk factors, and their effects are additive with respect to each other and other clinical indicators of risk.
在不稳定型冠状动脉疾病患者中，心肌损伤标志物肌钙蛋白T以及炎症标志物C反应蛋白和纤维蛋白原的血药浓度与短期死亡风险之间存在关联。利用在“冠状动脉疾病不稳定期使用达肝素”试验随访期延长期间获得的信息，我们评估了肌钙蛋白T、C反应蛋白和纤维蛋白原水平以及其他风险指标作为心脏原因导致长期死亡风险预测指标的有效性。
对917例纳入低分子量肝素治疗不稳定型冠状动脉疾病临床试验的患者，分析其入组时的C反应蛋白和纤维蛋白原水平以及入组后24小时内肌钙蛋白T的最高水平。患者平均随访37.0个月（范围1.6至50.6个月）。
随访期间，血肌钙蛋白T最高水平低于0.06微克/升的173例患者中，1.2%死于心脏原因，而肌钙蛋白T水平在0.06至0.59微克/升的367例患者中这一比例为8.7%，肌钙蛋白T水平至少为0.60微克/升的377例患者中这一比例为15.4%（P值分别为0.007和0.001）。血C反应蛋白水平低于2毫克/升的314例患者中，心脏原因导致的死亡率为5.7%，血C反应蛋白水平在2至10毫克/升的294例患者中这一比例为7.8%，血C反应蛋白水平高于10毫克/升的309例患者中这一比例为16.5%（P值分别为0.29和0.001）。血纤维蛋白原水平低于3.4克/升的314例患者中，心脏原因导致的死亡率为5.4%，血纤维蛋白原水平在3.4至3.9克/升的300例患者中这一比例为12.0%，血纤维蛋白原水平至少为4.0克/升的303例患者中这一比例为12.9%（P值分别为0.004和0.69）。多因素分析显示，肌钙蛋白T水平和C反应蛋白水平是心脏原因导致死亡风险的独立预测指标。
在不稳定型冠状动脉疾病中，肌钙蛋白T和C反应蛋白水平升高与心脏原因导致的长期死亡风险密切相关。这些标志物是独立的风险因素，它们彼此之间以及与其他临床风险指标的作用是相加的。
