Royal Victoria Hospital, Belfast, Northern Ireland, UK.
Adv Ther. 2009 May;26(5):531-4. doi: 10.1007/s12325-009-0032-7. Epub 2009 May 27.
Early identification of acute coronary syndrome (ACS) is important to guide therapy at a time when it is most likely to be of value. In addition, predicting future risk helps identify those most likely to benefit from ongoing therapy. Cardiac troponin T (cTnT) is useful for both purposes although cannot reliably rule out ACS until 12 hours after pain onset and does not fully define future risk. In this review article we summarize our previously published research, which assessed the value of myocyte injury, vascular inflammation, hemostatic, and neurohormonal markers in the early diagnosis of ACS and risk stratification of patients with ACS. In addition to cTnT, we measured heart fatty acid binding protein (H-FABP), glycogen phosphorylase-BB, high-sensitivity C-reactive protein, myeloperoxidase, matrix metalloproteinase 9, pregnancy-associated plasma protein-A, D-dimer, soluble CD40 ligand, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Of the 664 patients enrolled, 415 met inclusion criteria for the early diagnosis of acute myocardial infarction (MI) analysis; 555 were included in the risk stratification analysis and were followed for 1 year from admission. In patients presenting <4 hours from pain onset, initial H-FABP had higher sensitivity for acute MI than cTnT (73% vs. 55%; P=0.043) but was of no benefit beyond 4 hours when compared to cTnT. On multivariate analysis, H-FABP, NT-proBNP, and peak cTnT were independent predictors of 1-year death/MI. Our research demonstrated that, in patients presenting within 4 hours from pain onset, H-FABP may improve detection of ACS. Measuring H-FABP and proBNP may help improve long-term risk stratification.
早期识别急性冠状动脉综合征（ACS）对于指导治疗非常重要，因为此时治疗最有可能产生价值。此外，预测未来风险有助于确定最有可能从持续治疗中获益的患者。心肌肌钙蛋白 T（cTnT）在这两个方面都很有用，尽管在疼痛发作后 12 小时内仍不能可靠排除 ACS，并且不能完全确定未来的风险。在这篇综述文章中，我们总结了我们之前发表的研究，该研究评估了心肌损伤、血管炎症、止血和神经激素标志物在 ACS 的早期诊断和 ACS 患者的风险分层中的价值。除了 cTnT，我们还测量了心脏脂肪酸结合蛋白（H-FABP）、糖原磷酸化酶-BB、高敏 C 反应蛋白、髓过氧化物酶、基质金属蛋白酶 9、妊娠相关血浆蛋白 A、D-二聚体、可溶性 CD40 配体和 N 端脑钠肽前体（NT-proBNP）。在纳入的 664 名患者中，有 415 名符合急性心肌梗死（MI）分析的早期诊断标准；555 名患者纳入风险分层分析，并在入院后 1 年进行随访。在疼痛发作后<4 小时的患者中，初始 H-FABP 对急性 MI 的敏感性高于 cTnT（73% vs. 55%；P=0.043），但与 cTnT 相比，在 4 小时后无优势。多变量分析显示，H-FABP、NT-proBNP 和峰值 cTnT 是 1 年死亡/MI 的独立预测因素。我们的研究表明，在疼痛发作后 4 小时内就诊的患者中，H-FABP 可能有助于提高 ACS 的检出率。测量 H-FABP 和 proBNP 可能有助于改善长期风险分层。
