Mega Jessica L, Morrow David A, de Lemos James A, Mohanavelu Satishkumar, Cannon Christopher P, Sabatine Marc S
TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
J Am Coll Cardiol. 2008 Jun 24;51(25):2422-9. doi: 10.1016/j.jacc.2008.01.069.
We sought to test the prognostic performance of thrombus precursor protein (TpP) in patients presenting with an acute coronary syndrome (ACS).
Because thrombus formation is a critical step in the development of ACS, a measurement of activated coagulation could yield important information. Thrombus precursor protein is a biomarker that is used to measure soluble fibrin polymers, which are the penultimate products in fibrin formation.
We measured the levels of TpP in 284 healthy volunteers and in 2,349 patients with ACS.
Median TpP concentrations were 3.6 mug/ml (interquartile range 2.6 to 5.5) in the volunteers and 8.9 mug/ml (interquartile range 4.9 to 15.9) in the ACS patients (p < 0.001). Patients with ACS who had elevated TpP were older, more likely to be women, and more likely to have diabetes and pre-existing CAD (p < 0.02 for each). Thrombus precursor protein levels greater than the median were associated with a significantly increased risk for the composite of death, myocardial infarction (MI), or recurrent ischemia leading to rehospitalization or urgent revascularization through 10 months (hazard ratio [HR] 1.45, p < 0.001), as well as death or MI (HR 1.42, p = 0.02). We found that TpP correlated only weakly with cardiac troponin I, B-type natriuretic peptide, and high-sensitivity C-reactive protein (|r| <0.15 for each). After adjusting for clinical characteristics, cardiac troponin I, high-sensitivity C-reactive protein, and B-type natriuretic peptide, we found that patients with TpP levels greater than the median remained at significantly increased risk for the composite outcome (adjusted HR 1.51, p = 0.001) and death or MI (adjusted HR 1.58, p = 0.02).
In patients with ACS, increased levels of TpP are associated with an increased risk of death or ischemic complications. The incorporation of a marker of activated coagulation, such as TpP, with established cardiovascular risk factors may offer valuable complementary insight into risk assessment in ACS.
我们试图检测血栓前体蛋白（TpP）在急性冠状动脉综合征（ACS）患者中的预后性能。
由于血栓形成是ACS发生发展的关键步骤，检测活化凝血指标可能会提供重要信息。血栓前体蛋白是一种用于测量可溶性纤维蛋白聚合物的生物标志物，而可溶性纤维蛋白聚合物是纤维蛋白形成过程中的倒数第二个产物。
我们测量了284名健康志愿者和2349名ACS患者的TpP水平。
志愿者的TpP浓度中位数为3.6μg/ml（四分位间距为2.6至5.5），ACS患者为8.9μg/ml（四分位间距为4.9至15.9）（p<0.001）。TpP升高的ACS患者年龄更大，更可能为女性，且更可能患有糖尿病和既往冠心病（每项p<0.02）。血栓前体蛋白水平高于中位数与10个月内死亡、心肌梗死（MI）或导致再次住院或紧急血运重建的复发性缺血的复合风险显著增加相关（风险比[HR]1.45，p<0.001），以及死亡或MI（HR 1.42，p = 0.02）。我们发现TpP与心肌肌钙蛋白I、B型利钠肽和高敏C反应蛋白仅存在微弱相关性（每项|r|<0.15）。在对临床特征、心肌肌钙蛋白I、高敏C反应蛋白和B型利钠肽进行校正后，我们发现TpP水平高于中位数的患者发生复合结局的风险仍显著增加（校正HR 1.51，p = 0.001），死亡或MI的风险也显著增加（校正HR 1.58，p = 0.02）。
在ACS患者中，TpP水平升高与死亡或缺血性并发症风险增加相关。将活化凝血标志物（如TpP）与既定的心血管危险因素相结合，可能会为ACS的风险评估提供有价值的补充信息。
