Januzzi James L, Newby L Kristin, Murphy Sabina A, Pieper Karen, Antman Elliot M, Morrow David A, Sabatine Marc S, Ohman E Magnus, Cannon Christopher P, Braunwald Eugene
Cardiology Division, Massachusetts General Hospital, Boston, MA 02114, USA.
Am Heart J. 2006 Feb;151(2):360-6. doi: 10.1016/j.ahj.2005.04.021.
Troponin testing is useful for evaluating patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS); however, a significant percentage of patients are troponin negative at presentation and develop late rise of the marker.
Patients in the TIMI IIIB study were assessed with respect to their troponin I (TnI) status at presentation and 12 hours. Multivariable analysis identified independent clinical factors associated with TnI rise at 12 hours among subjects initially TnI negative. A score predicting late TnI rise in TIMI IIIB was developed using these factors and validated among patients in the GUSTO IIA study.
Of 1342 subjects in TIMI IIIB, 200 (14.9%) were negative at baseline, but developed an elevated TnI (> or = 0.4 ng/mL) at 12 hours. Six independent predictors of late TnI rise were identified: ST-segment deviation (odds ratio [OR] 3.52, 95% CI 2.38-5.23, P < .001), presentation < 8 hours from symptom onset (OR 2.91, 95% CI 1.92-4.40, P < .001), no prior percutaneous coronary intervention (OR 2.88, 95% CI 1.54-5.39, P = .001), no prior beta-blocker use (OR 1.74, 95% CI 1.15-2.63, P = .008), unheralded angina (OR 1.65, 95% CI 1.12-2.42, P = .01), and a history of myocardial infarction (OR 1.59, 95% CI 1.06-2.37, P = .02). ST deviation, presentation < 8 hours from symptoms, and no prior percutaneous coronary intervention were given a score of 2 points, whereas a score of 1 point was assigned to the other factors. Among baseline TnI-negative patients, a rising score was paralleled by an increasing prevalence of late TnI rise from 0% (with a score of 0) to 69% (with a score of 9) (P < .001). In confirmation, the score was able to similarly predict late troponin T rise among 855 patients in the GUSTO IIA study (P < .0001).
Development of late troponin rise is common in non-ST-segment elevation acute coronary syndromes. Six easily ascertained variables may be used to identify those at higher risk for late rise in troponin levels after an initially negative presentation.
肌钙蛋白检测对于评估非ST段抬高型急性冠脉综合征（NSTE ACS）患者很有用；然而，相当比例的患者在就诊时肌钙蛋白为阴性，且该标志物会出现延迟升高。
对TIMI IIIB研究中的患者在就诊时和12小时时的肌钙蛋白I（TnI）状态进行评估。多变量分析确定了初始TnI阴性的受试者中与12小时时TnI升高相关的独立临床因素。利用这些因素制定了一个预测TIMI IIIB研究中TnI延迟升高的评分，并在GUSTO IIA研究的患者中进行验证。
在TIMI IIIB研究的1342名受试者中，200名（14.9%）在基线时为阴性，但在12小时时TnI升高（≥0.4 ng/mL）。确定了6个TnI延迟升高的独立预测因素：ST段偏移（比值比[OR] 3.52，95%可信区间[CI] 2.38 - 5.23，P <.001）、症状发作后<8小时就诊（OR 2.91，95% CI 1.92 - 4.40，P <.001）、既往无经皮冠状动脉介入治疗（OR 2.88，95% CI 1.54 - 5.39，P =.001）、既往未使用β受体阻滞剂（OR 1.74，95% CI 1.15 - 2.63，P =.008）、静息性心绞痛（OR 1.65，95% CI 1.12 - 2.42，P =.01）以及心肌梗死病史（OR 1.59，95% CI 1.06 - 2.37，P =.02）。ST段偏移、症状发作后<8小时就诊以及既往无经皮冠状动脉介入治疗各得2分，而其他因素得1分。在基线TnI阴性的患者中，随着评分升高，TnI延迟升高的患病率从0%（评分为0时）增加到69%（评分为9时）（P <.001）。经证实，该评分能够在GUSTO IIA研究的855名患者中同样预测肌钙蛋白T的延迟升高（P <.0001）。
肌钙蛋白延迟升高在非ST段抬高型急性冠脉综合征中很常见。6个易于确定的变量可用于识别那些在初始表现为阴性后肌钙蛋白水平延迟升高风险较高的患者。
