Zhang Min, He Huiwei, Wang Ze-Mu, Xu Zhihui, Zhou Ningtian, Tao Zhengxian, Chen Bo, Li Chunjian, Zhu Tiebing, Yang Di, Wang Liansheng, Yang Zhijian
Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China;
Department of Geriatrics, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China;
J Biomed Res. 2014 Mar;28(2):98-107. doi: 10.7555/JBR.28.20130124. Epub 2014 Feb 10.
Cardiac troponin-I (cTnI) and -T (cTnT) are sensitive and specific markers of myocardial injury. However, the role of increased cTnI and cTnT in percutaneous coronary intervention (PCI)-related myocardial injury remains controversial. In this prospective, single-center and double-blind study, we aimed to determine the diagnostic and prognostic value of cTnI as well as cTnT (cTns) in PCI-related myocardial injury in a Chinese population. A total of 1,008 patients with stable angina pectoris and non-ST-segment elevation acute coronary syndrome were recruited. The levels of cTnI and cTnT were examined before and after PCI. All patients were followed up for 26±9 months to observe the incidence of major adverse cardiac events (MACEs). Our results showed that post-PCI cTnI and/or cTnT levels were increased to more than the 99(th) percentile upper reference limit (URL) in 133 (13.2%) patients, among which 22 (2.2%) were more than 5 × 99(th) percentile URL. By univariate analysis, an elevation in cTns after PCI was not an independent predictor of increased MACEs, HR 1.35 (P = 0.33, 95%CI: 0.74-2.46). In conclusion, our data demonstrate that the incidence of PCI-related myocardial injury is not common in a Chinese population and minor elevated cTns levels may not be a sensitive prognostic marker for MACEs.
心肌肌钙蛋白I（cTnI）和肌钙蛋白T（cTnT）是心肌损伤敏感且特异的标志物。然而，cTnI和cTnT升高在经皮冠状动脉介入治疗（PCI）相关心肌损伤中的作用仍存在争议。在这项前瞻性、单中心、双盲研究中，我们旨在确定cTnI以及cTnT（cTns）在中国人群PCI相关心肌损伤中的诊断和预后价值。共纳入1008例稳定型心绞痛和非ST段抬高型急性冠状动脉综合征患者。在PCI前后检测cTnI和cTnT水平。所有患者随访26±9个月，观察主要不良心脏事件（MACEs）的发生率。我们的结果显示，133例（13.2%）患者PCI后cTnI和/或cTnT水平升高超过第99百分位上限参考值（URL），其中22例（2.2%）超过5倍第99百分位URL。单因素分析显示，PCI后cTns升高不是MACEs增加的独立预测因素，风险比（HR）为1.35（P = 0.33，95%置信区间：0.74 - 2.46）。总之，我们的数据表明，在中国人群中，PCI相关心肌损伤的发生率并不常见，cTns水平轻度升高可能不是MACEs敏感的预后标志物。
