Kontos Michael C, Garg Rajat, Anderson F Philip, Tatum James L, Ornato Joseph P, Jesse Robert L
Cardiology Division, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Am Heart J. 2005 Oct;150(4):674-80. doi: 10.1016/j.ahj.2004.11.008.
The significance of troponin I (TnI) elevations in patients with renal failure (RF) admitted for possible myocardial ischemia is unclear. We therefore compared outcomes in patients with and without TnI elevations based on renal function.
Consecutive patients without ST elevation admitted for exclusion of ischemia underwent serial assessment of cardiac markers including TnI. Coronary angiography, significant disease, and revascularization were determined, and 1-year cardiac mortality and all-cause mortality were assessed. Mortality was assessed based on TnI elevations in patients with no (creatinine clearance [CrCl] > or = 60 mL/min), moderate (CrCl 30-59 mL/min), and severe (CrCl < 30 mL/min) RF.
Troponin I elevations were present in 17% of the 3774 consecutive patients and were significantly more frequent in patients with RF (CrCl < 30 mL/min: 26%; CrCl 30-59 mL/min: 19%; CrCl > 60 mL/min: 13%, all P < or = .01). Coronary angiography was performed significantly less frequently in patients with RF, whether TnI elevations were present. One-year all-cause mortality increased with both RF and TnI positivity (TnI [+] vs TnI [-], CrCl < 30 mL/min: 52% vs 26%; CrCl 30-59 mL/min: 21% vs 14%; CrCl > 60 mL/min: 8.9% vs 4.9%, all P < .001) . Troponin I was the most important independent predictor of mortality in the 3 RF groups (odds ratio 3.3 for CrCl < 30 mL/min, 2.2 for CrCl 30-59 mL/min, and 3.3 for CrCl > 60 mL/min).
Troponin I elevations identified a high-risk cohort, and its prognostic value was not diminished in patients with RF.
因可能的心肌缺血而入院的肾衰竭（RF）患者肌钙蛋白I（TnI）升高的意义尚不清楚。因此，我们根据肾功能比较了TnI升高和未升高患者的预后。
连续入选因排除缺血而入院且无ST段抬高的患者，对包括TnI在内的心脏标志物进行系列评估。确定冠状动脉造影、严重疾病和血运重建情况，并评估1年心脏死亡率和全因死亡率。根据无肾衰竭（肌酐清除率[CrCl]≥60 mL/分钟）、中度肾衰竭（CrCl 30 - 59 mL/分钟）和重度肾衰竭（CrCl＜30 mL/分钟）患者的TnI升高情况评估死亡率。
3774例连续患者中17%存在TnI升高，且在肾衰竭患者中更为常见（CrCl＜30 mL/分钟：26%；CrCl 30 - 59 mL/分钟：19%；CrCl＞60 mL/分钟：13%，P均≤0.01）。无论是否存在TnI升高，肾衰竭患者进行冠状动脉造影的频率均显著降低。1年全因死亡率随肾衰竭和TnI阳性而增加（TnI[+]与TnI[-]相比，CrCl＜30 mL/分钟：52%对26%；CrCl 30 - 59 mL/分钟：21%对14%；CrCl＞60 mL/分钟：8.9%对4.9%，P均＜0.001）。在3个肾衰竭组中，TnI是死亡率最重要的独立预测因素（CrCl＜30 mL/分钟时比值比为3.3，CrCl 30 - 59 mL/分钟时为2.2，CrCl＞60 mL/分钟时为3.3）。
TnI升高识别出了高危人群，其预后价值在肾衰竭患者中并未降低。
