Sanchis J, Bosch X, Bodí V, Bellera N, Núñez J, Benito B, Ordóñez J, Consuegra L, Heras M, Llècer A
Servei de Cardiologia, Hospital Clínic Universitari, Universitat de València, València, Spain.
Heart. 2008 Mar;94(3):311-5. doi: 10.1136/hrt.2007.115626. Epub 2007 Jul 16.
To investigate the combination of clinical data, exercise testing and biomarkers for the evaluation of patients with chest pain without ST-segment deviation or troponin elevation.
Prospective cohort design. SETTTING: Two teaching hospitals in Spain.
422 patients presenting to the emergency department were studied. Leukocyte count, C-reactive protein (CRP), pregnancy-associated plasma protein A (PAPP-A) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were determined. A validated clinical risk score (number of points according to pain characteristics and risk factors) was used for clinical evaluation and early exercise testing was performed.
Adverse events (death, myocardial infarction or revascularisation) during a median 60 weeks follow-up.
By receiver operating characteristic curve analysis, the association between death or myocardial infarction and adverse events was not significant with leukocyte count (p = 0.3, p = 0.3) or CRP (p = 0.5, p = 0.8), was borderline significant with PAPP-A (p = 0.07, p = 0.04) and strongly significant with NT-pro-BNP (p = 0.0001, p = 0.0001). By Cox regression including clinical risk score, exercise testing result and biomarkers, exercise testing was the independent predictor of revascularisation (p = 0.0001), whereas risk score (p = 0.03) and NT-proBNP (p = 0.0004) predicted death or myocardial infarction. The inclusion of NT-proBNP improved the accuracy of the model for death or myocardial infarction (C-statistic 0.84 versus 0.76, p = 0.01). The combination of clinical score and NT-proBNP afforded the stratification in high (17.2%, p = 0.0001), intermediate (5.3%) and low (1.1%) risk categories of death or myocardial infarction.
NT-proBNP provides incremental prognostic information above that given by clinical history and exercise testing in patients with chest pain without ST-segment deviation and negative troponin.
研究临床数据、运动试验和生物标志物相结合用于评估无ST段偏移或肌钙蛋白升高的胸痛患者。
前瞻性队列研究。
西班牙的两家教学医院。
对422名到急诊科就诊的患者进行研究。测定白细胞计数、C反应蛋白（CRP）、妊娠相关血浆蛋白A（PAPP-A）和N末端脑钠肽前体（NT-proBNP）。使用经过验证的临床风险评分（根据疼痛特征和危险因素的得分）进行临床评估，并进行早期运动试验。
中位随访60周期间的不良事件（死亡、心肌梗死或血运重建）。
通过受试者工作特征曲线分析，白细胞计数（p = 0.3，p = 0.3）或CRP（p = 0.5，p = 0.8）与死亡或心肌梗死及不良事件之间的关联不显著，PAPP-A的关联接近显著（p = 0.07，p = 0.04），NT-pro-BNP的关联高度显著（p = 0.0001，p = 0.0001）。通过Cox回归分析，纳入临床风险评分、运动试验结果和生物标志物后，运动试验是血运重建的独立预测因素（p = 0.0001），而风险评分（p = 0.03）和NT-proBNP（p = 0.0004）可预测死亡或心肌梗死。纳入NT-proBNP提高了死亡或心肌梗死模型的准确性（C统计量0.84对0.76，p = 0.01）。临床评分与NT-proBNP相结合可将死亡或心肌梗死分为高风险（17.2%，p = 0.0001）、中风险（5.3%）和低风险（1.1%）类别。
对于无ST段偏移且肌钙蛋白阴性的胸痛患者，NT-proBNP提供了超出临床病史和运动试验的额外预后信息。
