Newby L K, Ohman E M, Christenson R H, Moliterno D J, Harrington R A, White H D, Armstrong P W, Van De Werf F, Pfisterer M, Hasselblad V, Califf R M, Topol E J
Duke Clinical Research Institute, Durham, NC, USA.
Circulation. 2001 Jun 19;103(24):2891-6. doi: 10.1161/01.cir.103.24.2891.
Troponin T (TnT) is valuable for short- and long-term risk stratification of patients with acute coronary syndromes (ACS). It also may predict which ACS patients will benefit from glycoprotein (GP) IIb/IIIa blockade.
We prospectively studied 1160 patients with non-ST-segment elevation ACS randomized in PARAGON-B to receive lamifiban, an intravenous GP IIb/IIIa antagonist, or placebo. TnT levels were obtained before study treatment began and 24 to 72 hours later; assays were performed by a blinded core laboratory. At baseline, 40.2% of patients were TnT-positive (>/=0.1 ng/mL); these patients were older and more often male or smokers. Patients positive at baseline had a significantly higher rate of the primary end point (composite of death, myocardial [re]infarction, or severe recurrent ischemia at 30 days; odds ratio, 1.5; 95% CI, 1.1 to 2.1) than those who were TnT-negative. Lamifiban was associated with significant reduction in the primary end point (from 19.4% to 11.0%, P=0.01) among TnT-positive patients but not among TnT-negative patients (11.2% for placebo versus 10.8% for lamifiban, P=0.86; P=0.08 for test of interaction between TnT status and treatment assignment). This pattern held for the end points of death alone and death or myocardial (re)infarction at 30 days. Peak TnT level at 48 hours did not differ with lamifiban treatment.
TnT predicts poor short-term outcomes in non-ST-segment elevation ACS. Treatment benefit with lamifiban is limited almost exclusively to TnT-positive patients, reducing 30-day adverse outcomes to a rate nearly identical to that of negative patients.
肌钙蛋白T（TnT）对于急性冠状动脉综合征（ACS）患者的短期和长期风险分层具有重要价值。它还可以预测哪些ACS患者将从糖蛋白（GP）IIb/IIIa受体阻滞剂治疗中获益。
我们对1160例非ST段抬高型ACS患者进行了前瞻性研究，这些患者在PARAGON-B试验中被随机分配接受静脉注射GP IIb/IIIa拮抗剂拉米非班或安慰剂治疗。在研究治疗开始前及24至72小时后检测TnT水平；检测由一个盲法中心实验室进行。基线时，40.2%的患者TnT呈阳性（≥0.1 ng/mL）；这些患者年龄较大，男性或吸烟者更为常见。基线时TnT阳性的患者发生主要终点事件（30天时死亡、心肌梗死或严重复发性缺血的复合终点；比值比，1.5；95%可信区间，1.1至2.1）的发生率显著高于TnT阴性患者。拉米非班可使TnT阳性患者的主要终点事件显著减少（从19.4%降至11.0%，P=0.01），但对TnT阴性患者无此作用（安慰剂组为11.2%，拉米非班组为10.8%，P=0.86；TnT状态与治疗分配之间的交互作用检验P=0.08）。这种模式在单独的死亡终点以及30天时死亡或心肌梗死终点中均成立。48小时时的TnT峰值水平在拉米非班治疗组与安慰剂组之间无差异。
TnT可预测非ST段抬高型ACS患者的短期不良预后。拉米非班的治疗益处几乎仅限于TnT阳性患者，可将其30天不良结局发生率降至与TnT阴性患者几乎相同的水平。
