Bouzas-Mosquera Alberto, Peteiro Jesús, Broullón Francisco J, Constanso Ignacio P, Rodríguez-Garrido Jorge L, Martínez Dolores, Yáñez Juan C, Bescos Hildegart, Álvarez-García Nemesio, Vázquez-Rodríguez José Manuel
Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
Eur J Intern Med. 2016 Mar;28:59-64. doi: 10.1016/j.ejim.2015.10.004. Epub 2015 Oct 27.
BACKGROUND/OBJECTIVES: Patients with suspected acute coronary syndromes and negative cardiac troponin (cTn) levels are deemed at low risk. Our aim was to assess the effect of cTn levels on the frequency of inducible myocardial ischemia and subsequent coronary events in patients with acute chest pain and cTn levels within the normal range.
We evaluated 4474 patients with suspected acute coronary syndromes, nondiagnostic electrocardiograms and serial cTnI levels below the diagnostic threshold for myocardial necrosis using a conventional or a sensitive cTnI assay. The end points were the probability of inducible myocardial ischemia and coronary events (i.e., coronary death, myocardial infarction or coronary revascularization within 3 months).
The probability of inducible myocardial ischemia was significantly higher in patients with detectable peak cTnI levels (25%) than in those with undetectable concentrations (14.6%, p<0.001). These results were consistent regardless of the type of cTnI assay, the type of stress testing modality, or the timing for cTnI measurement, and remained significant after multivariate adjustment (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.21-1.79, p<0.001). The rate of coronary events at 3 months was also significantly higher in patients with detectable cTnI levels (adjusted OR 2.08, 95% CI 1.64-2.64, p<0.001).
Higher cTnI levels within the normal range were associated with a significantly increased probability of inducible myocardial ischemia and coronary events in patients with suspected acute coronary syndromes and seemingly negative cTnI.
背景/目的：疑似急性冠脉综合征且心肌肌钙蛋白（cTn）水平阴性的患者被认为风险较低。我们的目的是评估cTn水平对急性胸痛且cTn水平在正常范围内的患者诱发心肌缺血频率和随后发生冠脉事件的影响。
我们使用传统或敏感的cTnI检测方法，评估了4474例疑似急性冠脉综合征、心电图无诊断意义且连续cTnI水平低于心肌坏死诊断阈值的患者。终点是诱发心肌缺血和冠脉事件的概率（即3个月内的冠脉死亡、心肌梗死或冠脉血运重建）。
可检测到峰值cTnI水平的患者诱发心肌缺血的概率（25%）显著高于未检测到cTnI浓度的患者（14.6%，p<0.001）。无论cTnI检测方法的类型、负荷试验方式的类型或cTnI测量的时间如何，这些结果都是一致的，并且在多变量调整后仍然显著（优势比[OR]1.47，95%置信区间[CI]1.21-1.79，p<0.001）。cTnI水平可检测到的患者3个月时的冠脉事件发生率也显著更高（调整后OR 2.08，95%CI 1.64-2.64，p<0.001）。
在疑似急性冠脉综合征且看似cTnI阴性的患者中，正常范围内较高的cTnI水平与诱发心肌缺血和冠脉事件的概率显著增加相关。
