Alhadi Hafidh A, Fox Keith A A
Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.
Sultan Qaboos Univ Med J. 2010 Apr;10(1):31-40. Epub 2010 Apr 17.
The aim of this study was to assess the diagnostic and prognostic value of heart-type fatty acid-binding protein (H-FABP) in elective percutaneous coronary intervention (PCI) and compare it with standard cardiac markers.
A prospective evaluation was done of 80 consecutive patients admitted for elective PCI. Serum cardiac troponin T (cTnT), cardiac troponin I (cTnI), creatine kinase-MB (CK-MB mass), myoglobin, and H-FABP were determined pre-angioplasty and 1, 2, 4, and 16-24 hrs post-angioplasty. Elevated cardiac markers were correlated with demographic, angiographic and procedural variables. Patients were followed up for 20-26 months.
H-FABP peaked early at 2 hours and was useful for the early detection of evolving AMI within 1-3 hours after angioplasty. Cardiac-TnI, myoglobin, H-FABP, CK-MB mass, and cTnT concentrations were elevated in 46.25%, 17.5%, 13.3%, 11.25%, and 7.5% respectively. Cardiac-TnI was the most sensitive marker for detecting all complications and was superior to all other markers. Elevated cardiac markers were correlated with old age (P < 0.02); chest pain ± ECG changes of ischaemia (P < 0.003); use of stents (P < 0.019) and major complications such as major dissection (P < 0.004); transient vessel closure (P < 0.022); bail out stent (P < 0.003), and AMI (P < 0.042). Elevated cardiac markers were associated with a reduction of event-free survival (16.92 versus 20.67 months, P < 0.03).
Heart-type-FABP measurements at 1 hour (or thereafter) post-PCI may offer an early chance of detecting evolving AMI; cTnI was the most sensitive marker for the detection of major complications in patients undergoing PCI. Measurements of cTnI 16-24 hours post-PCI should be part of the routine management of patients following elective PCI.
本研究旨在评估心脏型脂肪酸结合蛋白（H-FABP）在择期经皮冠状动脉介入治疗（PCI）中的诊断和预后价值，并将其与标准心脏标志物进行比较。
对80例连续接受择期PCI的患者进行前瞻性评估。在血管成形术前以及血管成形术后1、2、4和16 - 24小时测定血清心肌肌钙蛋白T（cTnT）、心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶MB（CK-MB质量）、肌红蛋白和H-FABP。将升高的心脏标志物与人口统计学、血管造影和手术变量进行关联分析。对患者进行20 - 26个月随访。
H-FABP在术后2小时早期达到峰值，有助于在血管成形术后1 - 3小时内早期检测急性心肌梗死（AMI）的进展情况。心肌肌钙蛋白I（Cardiac-TnI）、肌红蛋白、H-FABP、CK-MB质量和cTnT浓度升高的患者分别占46.25%、17.5%、13.3%、11.25%和7.5%。Cardiac-TnI是检测所有并发症最敏感的标志物，优于所有其他标志物。升高的心脏标志物与老年（P < 0.02）；胸痛±缺血性心电图改变（P < 0.003）；使用支架（P < 0.019）以及主要并发症如严重夹层（P < 0.004）；短暂血管闭塞（P < 0.022）；补救性支架（P < 0.003）和AMI（P < 0.042）相关。升高的心脏标志物与无事件生存期缩短相关（16.92个月对20.67个月，P < 0.03）。
PCI术后1小时（或之后）测定心脏型脂肪酸结合蛋白（Heart-type-FABP）可能为检测进展性AMI提供早期机会；cTnI是检测接受PCI患者主要并发症最敏感的标志物。PCI术后16 - 24小时测定cTnI应成为择期PCI术后患者常规管理的一部分。
