East Carolina Heart Institute at East Carolina University, Greenville, North Carolina 27834, USA.
Clin Cardiol. 2009 Oct;32(10):575-83. doi: 10.1002/clc.20662.
The prognostic value of peak cardiac troponin (cTn) in different types of acute myocardial infarction (AMI) under the universal clinical classification is unknown.
We tested the hypothesis that the prognostic value of cTn varies with its peak level and type of AMI.
We studied 345 consecutive patients with AMI with mean follow-up of 30.6 months according to quartiles of peak cTn level (QPTL) and the type of AMI. The study outcomes were the major adverse cardiovascular events (MACE; composite of all causes of mortality and recurrent AMI) and the individual components of MACE.
The study included patients with AMI Type 1 (n = 276), type 2 (n = 54), ST-segment elevation myocardial infarction (STEMI; n = 159), and non-ST-segment elevation myocardial infarction (NSTEMI; n = 186). Overall, peak cTn level was an independent predictor of MACE (hazard ratio [HR]: 1.001, 95% confidence interval [CI]: 1.000-1.003, P = 0.01) and death (HR: 1.002, 95% CI: 1.001-1.004, P = 0.003), but not of recurrent AMI. The highest risk of MACE and death was in the highest QPTL (61.6%, P = .016 and 66.3%, P = 0.021, respectively) while the highest risk of recurrent AMI was in the lowest QPTL (83.7%, P = 0.04). Quartiles of peak cTn level were significantly associated with increased risk of MACE and death in patients with Type 1 (all P = 0.01) and STEMI (P = 0.01 and P = 0.02, respectively), but no association existed in type 2 or NSTEMI patients.
Overall, peak cTn predicts the risk of MACE and death but not the risk of AMI. While in Type 1 and STEMI patients, QPTL are associated with risk of MACE and death, no association exists in type 2 or NSTEMI patients.
在通用临床分类下，不同类型急性心肌梗死（AMI）患者的峰值心脏肌钙蛋白（cTn）的预后价值尚不清楚。
我们检验了这样一个假设，即 cTn 的预后价值与其峰值水平和 AMI 类型有关。
我们根据峰值 cTn 水平（QPTL）四分位数和 AMI 类型，对 345 例连续 AMI 患者进行了研究，平均随访 30.6 个月。研究结果是主要不良心血管事件（MACE；包括所有原因死亡和复发性 AMI）和 MACE 的各个组成部分。
研究包括 AMI 类型 1（n = 276）、类型 2（n = 54）、ST 段抬高心肌梗死（STEMI；n = 159）和非 ST 段抬高心肌梗死（NSTEMI；n = 186）患者。总体而言，峰值 cTn 水平是 MACE（危险比[HR]：1.001，95%置信区间[CI]：1.000-1.003，P = 0.01）和死亡（HR：1.002，95%CI：1.001-1.004，P = 0.003）的独立预测因素，但不是复发性 AMI 的独立预测因素。在最高 QPTL 中，MACE 和死亡的风险最高（61.6%，P =.016 和 66.3%，P = 0.021），而在最低 QPTL 中，复发性 AMI 的风险最高（83.7%，P = 0.04）。在类型 1（均 P = 0.01）和 STEMI 患者（P = 0.01 和 P = 0.02）中，QPTL 与 MACE 和死亡风险显著相关，但在类型 2 或 NSTEMI 患者中则没有相关性。
总的来说，峰值 cTn 可预测 MACE 和死亡风险，但不能预测 AMI 风险。在类型 1 和 STEMI 患者中，QPTL 与 MACE 和死亡风险相关，但在类型 2 或 NSTEMI 患者中则没有相关性。
