Bhatt Hemal A, Sanghani Dharmesh R, Lee David, Julliard Kell N, Fernaine George A
Department of Internal Medicine, Lutheran Medical Center, Brooklyn, New York.
Department of Cardiology, Lutheran Medical Center, Brooklyn, New York.
Int J Angiol. 2016 Mar;25(1):54-63. doi: 10.1055/s-0035-1547396. Epub 2015 Mar 23.
The peak troponin level has been associated with cardiovascular (CV) mortality and adverse CV events. The association of peak troponin with CV risk factors and severity and complexity of coronary artery disease remains unknown. We assessed the predictors of peak troponin in patients with acute coronary syndrome (ACS). This study aims to determine the predictors of peak troponin in ACS. Cardiac catheterization (CC) reports and electronic medical records from 2010 to 2013 were retrospectively reviewed. A total of 219 patients were eligible for the study. All major CV risk factors, comorbidities, laboratory data, CC indications, and coronary lesion characteristics were included. Univariate and multivariate regression analyses were done. On multivariate linear regression analysis, ST-elevation myocardial infarction (p = 0.001, β = 65.16) and increasing synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score (p = 0.002, β = 1.15) were associated with higher peak troponin. The Pearson correlation between SYNTAX score and peak troponin was r = 0.257, p = 0.001. History of daily aspirin use was associated with lower peak troponin (p = 0.002, β = -24.32). Prior statin use (p = 0.321, β = -8.98) and the presence of CV risk factors were not associated with peak troponin. Coronary artery disease severity and complexity, urgency of CC, and prior aspirin use are associated with peak troponin levels in ACS. Our findings may help predict patient population with ACS who would be at a greater risk for short- and long-term CV morbidity and mortality due to elevated peak troponin.
肌钙蛋白峰值水平与心血管（CV）死亡率及不良CV事件相关。肌钙蛋白峰值与CV危险因素、冠状动脉疾病的严重程度和复杂性之间的关联尚不清楚。我们评估了急性冠状动脉综合征（ACS）患者肌钙蛋白峰值的预测因素。本研究旨在确定ACS患者肌钙蛋白峰值的预测因素。对2010年至2013年的心脏导管插入术（CC）报告和电子病历进行了回顾性分析。共有219例患者符合研究条件。纳入了所有主要的CV危险因素、合并症、实验室数据、CC指征和冠状动脉病变特征。进行了单因素和多因素回归分析。在多因素线性回归分析中，ST段抬高型心肌梗死（p = 0.001，β = 65.16）以及紫杉醇药物涂层支架冠状动脉介入治疗与心脏手术协同性（SYNTAX）评分的增加（p = 0.002，β = 1.15）与更高的肌钙蛋白峰值相关。SYNTAX评分与肌钙蛋白峰值之间的Pearson相关性为r = 0.257，p = 0.001。每日服用阿司匹林的病史与较低的肌钙蛋白峰值相关（p = 0.002，β = -24.32）。既往使用他汀类药物（p = 0.321，β = -8.98）以及CV危险因素的存在与肌钙蛋白峰值无关。冠状动脉疾病的严重程度和复杂性、CC的紧迫性以及既往使用阿司匹林与ACS患者的肌钙蛋白峰值水平相关。我们的研究结果可能有助于预测因肌钙蛋白峰值升高而在短期和长期CV发病和死亡方面风险更高的ACS患者群体。
