Prasad Abhiram, Singh Mandeep, Lerman Amir, Lennon Ryan J, Holmes David R, Rihal Charanjit S
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 2006 Nov 7;48(9):1765-70. doi: 10.1016/j.jacc.2006.04.102. Epub 2006 Oct 17.
The aim of this study was to evaluate whether, in patients with normal post-procedure CK-MB, an isolated elevation in cardiac troponin T (cTnT) predicts long-term survival.
Cardiac troponin T is a sensitive and specific marker of myonecrosis. There is little known about the incidence and prognostic significance of an isolated elevation of cTnT without a rise in creatine kinase (CK)-MB following PCI.
We evaluated the outcomes of 1,949 patients from the Mayo Clinic registry who had normal pre-procedure cTnT and CK-MB, required nonemergency percutaneous coronary intervention (PCI), and had normal CK-MB after the procedure.
An elevation in cTnT (cTnT+) was observed in 383 patients (19.6%) (median 0.04 ng/ml, interquartile range 0.03 to 0.06 ng/ml). The TnT+ status was associated with adverse clinical and angiographic characteristics, and multivessel PCI. Over the median follow-up duration of 26 months, mortality (p < 0.001) and the combined rate of death and myocardial infarction (p = 0.004) were significantly higher in cTnT+ patients. Estimated 3-year survival for those with and without cTnT elevation was 86.9% and 93.2%, respectively. By multivariate analysis, an elevation in cTnT after PCI was an independent predictor of increased long-term mortality. A doubling in the post-PCI cTnT was associated with a partial hazard ratio of 1.20 (95% confidence interval 1.02 to 1.40; p = 0.023).
An isolated minor elevation in cTnT after PCI provides long-term prognostic information regarding mortality and myocardial infarction.
本研究旨在评估在术后肌酸激酶同工酶（CK-MB）正常的患者中，心脏肌钙蛋白T（cTnT）单独升高是否可预测长期生存情况。
心脏肌钙蛋白T是心肌坏死的敏感且特异的标志物。关于经皮冠状动脉介入治疗（PCI）后肌酸激酶（CK）-MB未升高而cTnT单独升高的发生率及预后意义，目前所知甚少。
我们评估了梅奥诊所登记处的1949例患者的预后情况，这些患者术前cTnT和CK-MB正常，需要进行非急诊经皮冠状动脉介入治疗（PCI），且术后CK-MB正常。
383例患者（19.6%）出现cTnT升高（cTnT+）（中位数为0.04 ng/ml，四分位间距为0.03至0.06 ng/ml）。TnT+状态与不良临床和血管造影特征以及多支血管PCI相关。在中位随访期26个月内，cTnT+患者的死亡率（p<0.001）以及死亡和心肌梗死的联合发生率（p = 0.004）显著更高。cTnT升高和未升高患者的估计3年生存率分别为86.9%和93.2%。多因素分析显示，PCI后cTnT升高是长期死亡率增加的独立预测因素。PCI后cTnT翻倍与部分风险比为1.20相关（95%置信区间为1.02至1.40；p = 0.023）。
PCI后cTnT单独轻度升高可提供关于死亡率和心肌梗死的长期预后信息。
