Greenberg Division of Cardiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10021, USA.
Catheter Cardiovasc Interv. 2011 Jun 1;77(7):1020-30. doi: 10.1002/ccd.22962. Epub 2011 May 13.
The aim of this meta-analysis was to assess the prevalence and prognostic value regarding mortality of cTnT or cTnI elevations after nonemergent percutaneous coronary intervention (PCI) in a large number of cohort/registry studies.
Routine cardiac troponin measurement after elective PCI has been controversial among interventionalists. Recent studies have provided conflicting data in regard to predictive value of cardiac troponin-T (cTnT) and troponin-I (cTnI) elevation after non-emergent PCI.
Electronic and manual searches were conducted of all published studies reporting on the prognostic impact of cTnT or cTnI elevation after elective PCI. A meta-analysis was performed with all-cause mortality at follow-up as the primary endpoint.
We identified 22 studies, involving 22,353 patients, published between 1998 and 2009. Postprocedural cTnT and cTnI were elevated in 25.9% and 34.3% of patients, respectively. Follow-up period ranged from 3 to 67 months (mean: 17.7 ± 14.9 months). The results showed no heterogeneity among the trials (Q-test: 25.39; I(2) : 17%; P = 0.23). No publication bias was detected (Egger's test: P = 0.16). The long-term all-cause mortality in patients with cTnI or cTnT elevation after PCI (5.8%) was significantly higher when compared to patients without cTnI or cTnT elevation (4.4%); OR 1.45 (95% CI: 1.22-1.72), P < 0.01. In addition, the postprocedural composite adverse clinical events of all-cause mortality or myocardial infarction (MI) in patients with cTnI or cTnT elevation after PCI (9.2%) was significantly higher when compared to patients without cTnI or cTnT elevation (5.3%); OR 1.77 (95% CI: 1.48-2.11), P < 0.01.
The current meta-analysis indicates that cTnI or cTnT elevation after nonemergent PCI is indicative of an increase in long-term all-cause mortality as well as the composite adverse events of all-cause mortality and MI. Efforts to routinely monitor periprocedural cTn levels along with more intensive outpatient monitoring/treatment of patients with cTn elevations may help to improve the long-term adverse outcomes in these patients following non-emergent PCI.
本荟萃分析旨在评估大量队列/注册研究中非紧急经皮冠状动脉介入治疗（PCI）后肌钙蛋白 T（cTnT）或肌钙蛋白 I（cTnI）升高的发生率和对死亡率的预测价值。
在择期 PCI 后常规测量心脏肌钙蛋白一直存在争议。最近的研究在非紧急 PCI 后 cTnT 和 cTnI 升高的预测价值方面提供了相互矛盾的数据。
对所有发表的研究进行电子和手动检索，这些研究报告了 cTnT 或 cTnI 升高对择期 PCI 后预后的影响。将全因死亡率作为主要终点进行荟萃分析。
我们确定了 22 项研究，涉及 22353 名患者，发表时间为 1998 年至 2009 年。术后 cTnT 和 cTnI 升高的患者分别占 25.9%和 34.3%。随访时间为 3 至 67 个月（平均：17.7±14.9 个月）。试验之间没有异质性（Q 检验：25.39；I²：17%；P=0.23）。未发现发表偏倚（Egger 检验：P=0.16）。与 cTnI 或 cTnT 升高的患者（5.8%）相比，PCI 后 cTnI 或 cTnT 升高的患者（4.4%）长期全因死亡率显著升高；OR 1.45（95%CI：1.22-1.72），P＜0.01。此外，与 cTnI 或 cTnT 不升高的患者（5.3%）相比，PCI 后 cTnI 或 cTnT 升高的患者（9.2%）的全因死亡率或心肌梗死（MI）复合不良临床事件发生率更高；OR 1.77（95%CI：1.48-2.11），P＜0.01。
目前的荟萃分析表明，非紧急 PCI 后 cTnI 或 cTnT 升高预示着长期全因死亡率以及全因死亡率和 MI 复合不良事件的增加。努力常规监测围手术期 cTn 水平，并对 cTn 升高的患者进行更强化的门诊监测/治疗，可能有助于改善这些患者非紧急 PCI 后的长期不良结局。
