Collinson Paul O, Gaynor Gloria H, Gaze David C
Department of Chemical Pathology, 2nd Floor Jenner Wing, St George's Hospital and Medical School, Blackshaw Road, London SW17 0QT, UK.
Ann Clin Biochem. 2008 Mar;45(Pt 2):184-8. doi: 10.1258/acb.2007.007050.
This study aimed at evaluating the ability of cardiac troponin I (cTnI) measurement on the ACS:180 for prognostic risk stratification. Sequential admissions to the coronary care unit of a busy district general hospital were studied. All patients were followed up for a maximum of 4.3 years and cardiac events, either cardiac death, readmission with acute myocardial infarction or admission with acute unstable angina were documented.
Blood samples were taken on admission and at 4 and 12 h. A serum aliquot was taken and stored frozen at -70 degrees C. The frozen aliquots were subsequently analysed for cTnI by chemiluminescent immunoassay using an ACS:180. Patients were categorized into those with or without ST segment elevation on the presenting electrocardiogram. The optimized decision threshold for mortality and event prediction was then determined by log-rank analysis and by construction of Kaplan-Meier survival plots.
A total of 289 patients (196 men) median age 65.3 years, range 27.4-87.9 years were studied. Out of this, 139 had ST elevation myocardial infarction (STEMI) and 150 had suspected non-STEMI (NSTEMI). Full data were available from 278 patients. Admission cTnI did not predict any of the endpoints in the STEMI group. In patients admitted with suspected NSTEMI, admission and peak cTnI predicted increased risk of death or readmission with acute myocardial infarction. In addition, peak cTnI predicted increased risk of death.
A cTnI exceeding 0.16 microg/L on admission or during hospital stay predicted an increased cardiac event rate at four years in patients admitted with suspected NSTEMI.
本研究旨在评估在ACS:180分析仪上检测心肌肌钙蛋白I（cTnI）对预后风险分层的能力。我们对一家繁忙的地区综合医院冠心病监护病房的连续入院患者进行了研究。所有患者均接受了最长4.3年的随访，并记录了心脏事件，包括心源性死亡、急性心肌梗死再入院或急性不稳定型心绞痛入院。
入院时、4小时和12小时采集血样。取一份血清样本并在-70℃冷冻保存。随后使用ACS:180分析仪通过化学发光免疫分析法对冷冻样本进行cTnI分析。根据患者入院时心电图有无ST段抬高进行分类。然后通过对数秩分析和构建Kaplan-Meier生存曲线来确定死亡率和事件预测的最佳决策阈值。
共研究了289例患者（196例男性），中位年龄65.3岁，年龄范围27.4 - 87.9岁。其中，139例为ST段抬高型心肌梗死（STEMI），150例为疑似非ST段抬高型心肌梗死（NSTEMI）。278例患者有完整数据。入院时cTnI不能预测STEMI组的任何终点事件。在疑似NSTEMI入院的患者中，入院时和cTnI峰值可预测死亡或急性心肌梗死再入院风险增加。此外，cTnI峰值还可预测死亡风险增加。
疑似NSTEMI入院患者入院时或住院期间cTnI超过0.16μg/L可预测4年内心脏事件发生率增加。
