Novack V, Jotkowitz A B, Cutlip D, Amit G, Liebermann N, Porath A
Department of Internal Medicine, Soroka University Medical Center, Beer-Sheba, Israel.
Postgrad Med J. 2008 Jan;84(987):50-5. doi: 10.1136/pgmj.2007.062018.
To examine the hypothesis that transition from creatine kinase MB subunits (CK-MB) to troponin as a more sensitive biomarker of myocardial necrosis reduced the 1 year mortality of non-ST elevation acute coronary syndrome (ACS) patients.
Retrospective population based cohort study performed in seven tertiary care hospitals in Israel. The patient population comprised all non-ST elevation ACS admissions during a 5 year period (1999-2004). CK-MB was the biomarker for the diagnosis of myocardial infarction (MI) at the time of admission in 14 037 patients (group 1), while 11 643 patients were admitted after the individual hospital laboratory switched to troponin (group 2). Incidence of ACS types, in-hospital management and 1 year survival was assessed.
Group 2 patients had a higher frequency of non-ST elevation MI diagnosis (27.9% vs 17.7%, p<0.001) and were more likely to undergo coronary catheterisation during hospitalisation (44.5% vs 37.5%, p<0.001). One year mortality in non-ST elevation MI was lower in group 2 compared to group 1 (24.6% vs 28.1%, p = 0.002). Similarly, the 1 year death rate in the unstable angina group decreased in group 2 compared to group 1 (7.7% vs 8.5%, p = 0.04). However, the overall non-ST elevation ACS 1 year mortality rate did not change (12.4% vs 11.9%, p = 0.27). In multivariate Cox proportional hazard analysis the transition from CK-MB to troponin had no significant effect on overall 1 year mortality (hazard ratio 0.95, 95% confidence interval 0.89 to 1.03).
Transition to troponin as a diagnostic marker of MI led to an increase in the incidence of non-ST elevation MI. This transition was not associated with a decrease in the 1 year non-ST elevation ACS mortality rate.
检验以下假设，即从肌酸激酶MB亚基（CK-MB）过渡到肌钙蛋白作为心肌坏死更敏感的生物标志物可降低非ST段抬高型急性冠状动脉综合征（ACS）患者的1年死亡率。
在以色列的7家三级护理医院进行的基于人群的回顾性队列研究。患者群体包括5年期间（1999 - 2004年）所有非ST段抬高型ACS入院患者。14037例患者（第1组）入院时CK-MB是诊断心肌梗死（MI）的生物标志物，而11643例患者在各医院实验室改用肌钙蛋白后入院（第2组）。评估ACS类型的发生率、住院期间的管理和1年生存率。
第2组患者非ST段抬高型MI诊断的频率更高（27.9%对17.7%，p<0.001），且住院期间更有可能接受冠状动脉导管插入术（44.5%对37.5%，p<0.001）。与第1组相比，第2组中非ST段抬高型MI的1年死亡率更低（24.6%对28.1%，p = 0.002）。同样，与第1组相比，第2组中不稳定型心绞痛组的1年死亡率有所下降（7.7%对8.5%，p = 0.04）。然而，非ST段抬高型ACS的总体1年死亡率没有变化（12.4%对11.9%，p = 0.27）。在多变量Cox比例风险分析中，从CK-MB过渡到肌钙蛋白对总体1年死亡率没有显著影响（风险比0.95，95%置信区间0.89至1.03）。
过渡到肌钙蛋白作为MI的诊断标志物导致非ST段抬高型MI的发生率增加。这种过渡与非ST段抬高型ACS 1年死亡率的降低无关。
