评价急性冠脉综合征患者围术期心肌梗死的肌钙蛋白 T 标准。

Evaluation of troponin T criteria for periprocedural myocardial infarction in patients with acute coronary syndromes.

机构信息

Department of Cardiology, University of New South Wales, Sydney, New South Wales, Australia.

出版信息

Am J Cardiol. 2011 Mar 15;107(6):863-70. doi: 10.1016/j.amjcard.2010.11.007.

DOI:10.1016/j.amjcard.2010.11.007

Abstract

In patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI), the diagnosis of periprocedural myocardial infarction is often problematic when the pre-PCI levels of cardiac troponin T (TnT) are elevated. Thus, we examined different TnT criteria for periprocedural myocardial infarction when the pre-PCI TnT levels were elevated and also the associations between the post-PCI cardiac marker levels and outcomes. We established the relation between the post-PCI creatine kinase-MB (CKMB) and TnT levels in 582 patients (315 with acute coronary syndromes and 272 with stable coronary heart disease). A post-PCI increase in the CKMB levels to 14.7 μg/L (3 × the upper reference limit [URL] in men) corresponded to a TnT of 0.23 μg/L. In the 85 patients with acute coronary syndromes and normal CKMB, but elevated post peak TnT levels before PCI (performed at a median of 5 days, interquartile range 3 to 7), the post-PCI cardiac marker increases were as follows: 21 (24.7%) with a ≥ 20% increase in TnT, 10 (11.8%) with an CKMB level >3 × URL, and 12 (14%) with an absolute TnT increase of >0.09 μg/L (p <0.005 for both). In the patients with stable coronary heart disease and post-PCI cardiac markers > 3× URL compared to those without markers elevations, the rate of freedom from death or nonfatal myocardial infarction was 88% for those with TnT elevations versus 99% (p <0.001, log-rank) and 84% for those with CKMB elevations versus 98% (p <0.001, log-rank). Of the patients with acute coronary syndromes, the post-PCI marker levels did not influence the outcomes. In conclusion, in patients with acute coronary syndromes and elevated TnT levels undergoing PCI several days later, ≥20% increases in TnT were more common than absolute increments in the TnT or CKMB levels of >3× URL. Also, periprocedural cardiac marker elevations in patients with acute coronary syndromes did not have prognostic significance.

摘要

在接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征患者中，当心脏肌钙蛋白 T（TnT）的术前水平升高时，围手术期心肌梗死的诊断通常存在问题。因此，我们研究了术前 TnT 水平升高时不同的 TnT 标准用于围手术期心肌梗死，以及术后心脏标志物水平与结局之间的关系。我们在 582 例患者（急性冠状动脉综合征 315 例，稳定型冠心病 272 例）中建立了术后肌酸激酶同工酶-MB（CKMB）和 TnT 水平之间的关系。术后 CKMB 水平升高至 14.7μg/L（男性 3×参考上限[URL]）与 TnT 为 0.23μg/L 相对应。在 85 例急性冠状动脉综合征且 CKMB 正常但术前 TnT 峰值后升高的患者中（中位数为 5 天，四分位距为 3 至 7），术后心脏标志物的增加如下：21 例（24.7%）的 TnT 升高≥20%，10 例（11.8%）的 CKMB 水平>3×URL，12 例（14%）的 TnT 绝对值增加>0.09μg/L（两者均 p<0.005）。与无标志物升高的患者相比，在稳定型冠心病患者中，术后心脏标志物>3×URL 的患者中，TnT 升高者的无死亡或非致死性心肌梗死率为 88%，而 CKMB 升高者为 99%（p<0.001，对数秩检验），CKMB 升高者为 84%，而 CKMB 升高者为 98%（p<0.001，对数秩检验）。在急性冠状动脉综合征患者中，术后标志物水平对结局没有影响。总之，在接受 PCI 治疗数天后 TnT 水平升高的急性冠状动脉综合征患者中，TnT 升高≥20%比 TnT 绝对值增加>3×URL 或 CKMB 水平升高更常见。此外，急性冠状动脉综合征患者的围手术期心脏标志物升高没有预后意义。