比较急性心肌梗死患者肌酸激酶同工酶峰值和肌钙蛋白水平的预后价值：急性冠状动脉治疗和干预结局网络登记研究-遵循指南。
Comparison of the prognostic value of peak creatine kinase-MB and troponin levels among patients with acute myocardial infarction: a report from the Acute Coronary Treatment and Intervention Outcomes Network Registry-get with the guidelines.
机构信息
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA.
出版信息
Clin Cardiol. 2012;35(7):424-9. doi: 10.1002/clc.21980. Epub 2012 Mar 20.
BACKGROUND
Although peak creatine kinase-myocardial band (CK-MB) and troponin levels have been correlated with mortality among patients with acute myocardial infarction (AMI), the independent prognostic implications of these markers have not been compared.
HYPOTHESIS
We hypothesized that in patients with AMI, peak troponin levels (as compared to peak CK-MB levels) would have greater prognostic value.
METHODS
We examined AMI patients in the National Cardiovascular Data Registry ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines) with CK-MB and troponin I levels recorded, excluding patients who were transferred in or out. Peak marker levels, standardized by the local laboratory upper limit of normal and assay standard deviation, were fitted into the previously validated ACTION Registry-GWTG mortality model to compare prognostic value.
RESULTS
Between January 2007 and March 2009, 16 009 ST-segment elevation myocardial infarction (STEMI) and 26854 non-ST-segment elevation myocardial infarction (NSTEMI) patients were identified. Peak marker ratios were directly associated with in-hospital mortality in both STEMI and NSTEMI patients. Peak CK-MB had slightly greater discrimination compared with peak troponin I in predicting mortality in both STEMI (model C-statistic 0.881 vs 0.877, P = 0.011) and NSTEMI (C-statistic 0.831 vs 0.824, P = 0.001) patients.
CONCLUSIONS
Both peak CK-MB and peak troponin I levels are independently associated with in-hospital mortality in this large contemporary database of AMI patients treated in routine practice. Peak marker values slightly improved model performance in prognosticating in-hospital mortality; the incremental value was higher with CK-MB than with troponin I. These findings may help to guide future risk stratification algorithms and contribute to more efficient use of serial cardiac marker measurements in clinical practice.
背景
尽管肌酸激酶同工酶-心肌带（CK-MB）和肌钙蛋白水平与急性心肌梗死（AMI）患者的死亡率相关，但这些标志物的独立预后意义尚未进行比较。
假设
我们假设在 AMI 患者中，峰值肌钙蛋白水平（与峰值 CK-MB 水平相比）将具有更大的预后价值。
方法
我们检查了 National Cardiovascular Data Registry ACTION Registry-GWTG（急性冠状动脉治疗和干预结局网络注册-GET WITH THE GUIDELINES）中的 AMI 患者，记录了 CK-MB 和肌钙蛋白 I 水平，排除了转院的患者。通过将标记物峰值标准化为当地实验室正常值上限和检测标准偏差，将其拟合到先前验证的 ACTION Registry-GWTG 死亡率模型中，以比较预后价值。
结果
在 2007 年 1 月至 2009 年 3 月期间，共确定了 16009 例 ST 段抬高心肌梗死（STEMI）和 26854 例非 ST 段抬高心肌梗死（NSTEMI）患者。在 STEMI 和 NSTEMI 患者中，峰值标记物比值与住院死亡率直接相关。在预测 STEMI（模型 C 统计量为 0.881 与 0.877，P=0.011）和 NSTEMI（C 统计量为 0.831 与 0.824，P=0.001）患者的死亡率方面，峰值 CK-MB 比峰值肌钙蛋白 I 略有更好的区分度。
结论
在接受常规治疗的 AMI 患者的这个大型当代数据库中，峰值 CK-MB 和峰值肌钙蛋白 I 水平均与住院死亡率独立相关。峰值标记物值略微提高了预测住院死亡率的模型性能；CK-MB 的增量价值高于肌钙蛋白 I。这些发现可能有助于指导未来的风险分层算法，并有助于在临床实践中更有效地利用连续的心脏标志物测量。
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