Kaul Padma, Newby L Kristin, Fu Yuling, Hasselblad Vic, Mahaffey Kenneth W, Christenson Robert H, Harrington Robert A, Ohman E Magnus, Topol Eric J, Califf Robert M, Van de Werf Frans, Armstrong Paul W
Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
J Am Coll Cardiol. 2003 Feb 5;41(3):371-80. doi: 10.1016/s0735-1097(02)02824-3.
Our primary objective was to examine the prognostic relationship between baseline quantitative ST-segment depression (ST) and cardiac troponin T (cTnT) elevation. The secondary objectives were to: 1) examine whether ST provided additional insight into therapeutic efficacy of glycoprotein IIb/IIIa therapy similar to that demonstrated by cTnT; and 2) explore whether the time to evaluation impacted on each marker's relative prognostic utility.
The relationship between the baseline electrocardiogram (ECG) and cTnT measurements in risk-stratifying patients presenting with acute coronary syndromes (ACS) has not been evaluated comprehensively.
The study population consisted of 959 patients enrolled in the cTnT substudy of the Platelet IIb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in a Global Organization Network (PARAGON)-B trial. Patients were classified as having no ST (n = 387), 1 mm ST (n = 433), and ST > or =2 mm (n = 139). Forty-percent (n = 381) were classified as cTnT-positive based on a definition of > or =0.1 ng/ml.
Six-month death/(re)myocardial infarction rates were 8.4% among cTnT-negative patients with no ST and 26.8% among cTnT-positive patients with ST > or =2 mm. On ECGs done after 6 h of symptom onset, ST > or =2 mm was associated with higher risk compared to its presence on ECGs done earlier (odds ratio [OR] 7.3 vs. 2.1). In contrast, the presence of elevated cTnT within 6 h of symptom was associated with a higher risk of adverse events compared with elevations after 6 h (OR 2.4 vs. 1.5).
Quantitative ST and cTnT status are complementary in assessing risk among ACS patients and both should be employed to determine prognosis and assist in medical decision making.
我们的主要目的是研究基线定量ST段压低（ST）与心肌肌钙蛋白T（cTnT）升高之间的预后关系。次要目的是：1）研究ST是否能像cTnT那样为糖蛋白IIb/IIIa疗法的治疗效果提供额外的见解；2）探讨评估时间是否会影响每个标志物的相对预后效用。
在对急性冠状动脉综合征（ACS）患者进行风险分层时，基线心电图（ECG）与cTnT测量值之间的关系尚未得到全面评估。
研究人群包括959名参与全球组织网络血小板IIb/IIIa拮抗剂减少急性冠状动脉综合征事件（PARAGON）-B试验cTnT子研究的患者。患者被分为无ST段压低（n = 387）、ST段压低1 mm（n = 433）和ST段压低≥2 mm（n = 139）。根据≥0.1 ng/ml的定义，40%（n = 381）被分类为cTnT阳性。
在无ST段压低的cTnT阴性患者中，6个月死亡/（再）心肌梗死发生率为8.4%，在ST段压低≥2 mm的cTnT阳性患者中为26.8%。在症状发作6小时后进行的心电图检查中，与早期心电图相比，ST段压低≥2 mm与更高风险相关（优势比[OR] 7.3对2.1）。相比之下，症状出现6小时内cTnT升高与6小时后升高相比，不良事件风险更高（OR 2.4对1.5）。
定量ST段压低和cTnT状态在评估ACS患者风险方面具有互补性，两者都应用于确定预后并协助医疗决策。
