Foussas S G, Zairis M N, Makrygiannis S S, Manousakis S J, Anastassiadis F A, Apostolatos C S, Patsourakos N G, Glyptis M P, Papadopoulos J K, Xenos D C, Adamopoulou E N, Olympios C D, Argyrakis S K
Department of Cardiology, 40 Acti Themistokleous Street, Piraeus 18537, Greece.
Heart. 2007 Aug;93(8):952-6. doi: 10.1136/hrt.2005.084954. Epub 2007 Mar 7.
To evaluate, using continuous 12-lead ECG ST-segment monitoring, the role of circulating levels of both cardiac troponin I (cTnI) and high-sensitivity C reactive protein (hs-CRP), on presentation, in the prediction of intravenous thrombolysis outcome in patients with ST-segment elevation myocardial infarction (STEMI).
Prospective observational study in a tertiary referral centre.
786 consecutive patients with STEMI, who received intravenous thrombolysis in the first 6 h from index pain.
The incidence of failed thrombolysis and of cardiac death by 30 days. Failed thrombolysis was defined as the absence of abrupt and sustained > or =50% ST-segment recovery in the first 90 min after the initiation of intravenous thrombolysis.
The incidence of failed thrombolysis and 30-day cardiac death was 57.4% and 11.8%, respectively. By multivariate logistic regression analysis according to tertiles of both cTnI (RR, 1.5; 95% CI 1.1 to 1.8, p = 0.004 for highest vs middle third; 2.2, 1.9 to 3.5, p<0.001 for highest vs lowest third; 1.5, 1.2 to 1.8, p = 0.001 for middle vs lowest third) and hs-CRP (RR, 2.0, 95% CI, 1.6 to 2.2; p<0.001 for highest vs middle third; 2.6, 2.1 to 3.5, p<0.001 for highest vs lowest third; 1.3, 1.2 to 1.7, p = 0.02 for middle vs lowest third), were independently associated with failed thrombolysis. Moreover, by multivariate Cox regression analysis according to tertiles of both cTnI (HR 1.2, 95% CI 1.1 to 1.8, p = 0.03 for highest vs middle third; 1.5, 1.2 to 2.2, p = 0.004 for highest vs lowest third; 1.1, 0.6 to 1.4, p = 0.6 for middle vs lowest third) and hs-CRP (HR1.2, 95% CI 1.1 to 1.6, p = 0.04 for highest vs middle third; 1.7, 1.3 to 2.6, p = 0.001 for highest vs lowest third; 1.1, 0.9 to 2.1, p = 0.1 for middle vs lowest third), were independently related with an increased risk of 30-day cardiac death.
High circulating levels of both cTnI and hs-CRP are related with an independent increased risk of intravenous thrombolysis failure and 30-day cardiac death in patients who received intravenous thrombolysis in the first 6 h of STEMI.
采用连续12导联心电图ST段监测，评估心肌肌钙蛋白I（cTnI）和高敏C反应蛋白（hs-CRP）的循环水平在ST段抬高型心肌梗死（STEMI）患者就诊时对静脉溶栓结局预测中的作用。
在一家三级转诊中心进行的前瞻性观察性研究。
786例连续的STEMI患者，在首次疼痛发作后的6小时内接受了静脉溶栓治疗。
溶栓失败的发生率和30天内心脏死亡的发生率。溶栓失败定义为在静脉溶栓开始后的最初90分钟内，ST段未出现突然且持续的≥50%恢复。
溶栓失败和30天心脏死亡的发生率分别为57.4%和11.8%。根据cTnI的三分位数进行多因素logistic回归分析（最高三分位数与中间三分位数相比，RR为1.5；95%CI为1.1至1.8，p = 0.004；最高三分位数与最低三分位数相比，RR为2.2，1.9至3.5，p<0.001；中间三分位数与最低三分位数相比，RR为1.5，1.2至1.8，p = 0.001）以及hs-CRP（最高三分位数与中间三分位数相比，RR为2.0，95%CI为1.6至2.2；p<0.001；最高三分位数与最低三分位数相比，RR为2.6，2.1至3.5，p<0.001；中间三分位数与最低三分位数相比，RR为1.3，1.2至1.7，p = 0.02），均与溶栓失败独立相关。此外，根据cTnI的三分位数进行多因素Cox回归分析（最高三分位数与中间三分位数相比，HR为1.2，95%CI为1.1至1.8，p = 0.03；最高三分位数与最低三分位数相比，HR为1.5，1.2至2.2，p = 0.004；中间三分位数与最低三分位数相比，HR为1.1，0.6至1.4，p = 0.6）以及hs-CRP（最高三分位数与中间三分位数相比，HR为1.2，95%CI为1.1至1.6，p = 0.04；最高三分位数与最低三分位数相比，HR为1.7，1.3至2.6，p = 0.001；中间三分位数与最低三分位数相比，HR为1.1，0.9至2.1，p = 0.1），均与30天心脏死亡风险增加独立相关。
在STEMI发病后6小时内接受静脉溶栓治疗的患者中，cTnI和hs-CRP的高循环水平与静脉溶栓失败和30天心脏死亡的独立风险增加相关。
