TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Eur Heart J. 2011 Mar;32(6):697-705. doi: 10.1093/eurheartj/ehq468. Epub 2010 Dec 22.
The aim of this study is to simultaneously evaluate the incremental prognostic value of multiple cardiac biomarkers reflecting different underlying pathophysiological processes in a well-characterized population of patients with non-ST-segment acute coronary syndrome (NSTE-ACS).
We measured cardiac troponin I (cTnI), N-terminal pro B-type natriuretic peptide (NT-proBNP), C-reactive protein, and myeloperodixase (MPO) among 4352 patients with NSTE-ACS in the MERLIN-TIMI 36 (Metabolic Efficiency With Ranolazine for Less Ischaemia in Non-ST Elevation Acute Coronary-Thrombolysis In Myocardial Infarction 36) trial and followed them for a mean of 343 days. When added individually to a multivariable model adjusted for clinical characteristics, the risk of cardiovascular (CV) death rose in a stepwise fashion with increasing quartiles of each biomarker, and when using their pre-defined cut-points [HR(adj) 2.71 (P < 0.001) for cTnI ≥0.03 ng/mL; HR(adj) 3.01 (P < 0.001) for NT-proBNP ≥400 pg/mL; HR(adj) 1.45 (P = 0.019) for high-sensitivity (hs) C-reactive protein ≥15 mg/L; and HR(adj) 1.49 (P = 0.006) for MPO ≥670 pmol/L]. After including all biomarkers, only NT-proBNP and cTnI were independently associated with CV death, and only cTnI with myocardial infarction (MI). The addition of NT-proBNP to a model adjusted for TIMI risk score incorporating cTnI significantly improved both the discrimination and re-classification of the model for CV death and heart failure (HF) while there was no such improvement after the addition of either MPO or hs-C-reactive protein.
In this study of over 4300 patients presenting with NSTEACS, we found that both cTnI and NT-proBNP offer prognostic information beyond that achieved with clinical risk variables for CV death, MI, and HF. Myeloperoxidase and hs-C-reactive protein, while independently associated with some adverse CV outcomes, did not provide substantial incremental prognostic information when evaluated together with cTnI and NT-proBNP.
本研究旨在同时评估反映非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者不同潜在病理生理过程的多种心脏生物标志物的增量预后价值。
我们在 MERLIN-TIMI 36（瑞那唑胺减少非 ST 段抬高型急性冠状动脉血栓溶解心肌梗死 36 例的代谢效率）试验中测量了 4352 例 NSTE-ACS 患者的心肌肌钙蛋白 I（cTnI）、N 末端 pro B 型利钠肽前体（NT-proBNP）、C 反应蛋白和髓过氧化物酶（MPO），并对他们进行了平均 343 天的随访。当分别加入到一个包含临床特征的多变量模型中时，每个标志物的四分位数增加，心血管（CV）死亡的风险呈逐步上升趋势，当使用其预定义的截断值时 [cTnI≥0.03ng/ml 的 HR（adj）2.71（P<0.001）；NT-proBNP≥400pg/ml 的 HR（adj）3.01（P<0.001）；高敏（hs）C 反应蛋白≥15mg/L 的 HR（adj）1.45（P=0.019）；MPO≥670pmol/L 的 HR（adj）1.49（P=0.006）]。在纳入所有生物标志物后，只有 NT-proBNP 和 cTnI 与 CV 死亡独立相关，只有 cTnI 与心肌梗死（MI）相关。在纳入包含 cTnI 的 TIMI 风险评分的模型中加入 NT-proBNP 后，显著提高了模型对 CV 死亡和心力衰竭（HF）的区分度和再分类，而加入 MPO 或 hs-C 反应蛋白后则没有这种改善。
在这项超过 4300 例 NSTEACS 患者的研究中，我们发现 cTnI 和 NT-proBNP 均提供了比临床风险变量更有价值的 CV 死亡、MI 和 HF 预后信息。髓过氧化物酶和 hs-C 反应蛋白虽然与某些不良 CV 结局独立相关，但在与 cTnI 和 NT-proBNP 一起评估时，并未提供实质性的增量预后信息。
