接受择期经皮冠状动脉介入治疗的稳定型冠状动脉疾病患者术前高敏心肌肌钙蛋白T与临床结局
Preprocedural High-Sensitivity Cardiac Troponin T and Clinical Outcomes in Patients With Stable Coronary Artery Disease Undergoing Elective Percutaneous Coronary Intervention.
作者信息
Zanchin Thomas, Räber Lorenz, Koskinas Konstantinos C, Piccolo Raffaele, Jüni Peter, Pilgrim Thomas, Stortecky Stefan, Khattab Ahmed A, Wenaweser Peter, Bloechlinger Stefan, Moschovitis Aris, Frenk Andre, Moro Christina, Meier Bernhard, Fiedler Georg M, Heg Dik, Windecker Stephan
机构信息
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
出版信息
Circ Cardiovasc Interv. 2016 Jun;9(6). doi: 10.1161/CIRCINTERVENTIONS.115.003202.
BACKGROUND
Cardiac troponin detected by new-generation, highly sensitive assays predicts clinical outcomes among patients with stable coronary artery disease (SCAD) treated medically. The prognostic value of baseline high-sensitivity cardiac troponin T (hs-cTnT) elevation in SCAD patients undergoing elective percutaneous coronary interventions is not well established. This study assessed the association of preprocedural levels of hs-cTnT with 1-year clinical outcomes among SCAD patients undergoing percutaneous coronary intervention.
METHODS AND RESULTS
Between 2010 and 2014, 6974 consecutive patients were prospectively enrolled in the Bern Percutaneous Coronary Interventions Registry. Among patients with SCAD (n=2029), 527 (26%) had elevated preprocedural hs-cTnT above the upper reference limit of 14 ng/L. The primary end point, mortality within 1 year, occurred in 20 patients (1.4%) with normal hs-cTnT versus 39 patients (7.7%) with elevated baseline hs-cTnT (P<0.001). Patients with elevated hs-cTnT had increased risks of all-cause (hazard ratio 5.73; 95% confidence intervals 3.34-9.83; P<0.001) and cardiac mortality (hazard ratio 4.68; 95% confidence interval 2.12-10.31; P<0.001). Preprocedural hs-TnT elevation remained an independent predictor of 1-year mortality after adjustment for relevant risk factors, including age, sex, and renal failure (adjusted hazard ratio 2.08; 95% confidence interval 1.10-3.92; P=0.024). A graded mortality risk was observed across higher tertiles of elevated preprocedural hs-cTnT, but not among patients with hs-cTnT below the upper reference limit.
CONCLUSIONS
Preprocedural elevation of hs-cTnT is observed in one fourth of SCAD patients undergoing elective percutaneous coronary intervention. Increased levels of preprocedural hs-cTnT are proportionally related to the risk of death and emerged as independent predictors of all-cause mortality within 1 year.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02241291.
背景
新一代高敏检测法检测的心肌肌钙蛋白可预测接受药物治疗的稳定型冠状动脉疾病（SCAD）患者的临床结局。基线高敏心肌肌钙蛋白T（hs-cTnT）升高在接受择期经皮冠状动脉介入治疗的SCAD患者中的预后价值尚未明确。本研究评估了经皮冠状动脉介入治疗的SCAD患者术前hs-cTnT水平与1年临床结局之间的关联。
方法与结果
2010年至2014年期间，6974例连续患者前瞻性纳入伯尔尼经皮冠状动脉介入治疗注册研究。在SCAD患者（n = 2029）中，527例（26%）术前hs-cTnT升高超过14 ng/L的参考上限。主要终点为1年内死亡率，hs-cTnT正常的20例患者（1.4%）与基线hs-cTnT升高的39例患者（7.7%）出现该情况（P<0.001）。hs-cTnT升高的患者全因死亡风险增加（风险比5.73；95%置信区间3.34 - 9.83；P<0.001）和心脏死亡风险增加（风险比4.68；95%置信区间2.12 - 10.31；P<0.001）。在调整包括年龄、性别和肾衰竭等相关危险因素后，术前hs-TnT升高仍是1年死亡率的独立预测因素（调整后风险比2.08；95%置信区间1.10 - 3.92；P = 0.024）。在术前hs-cTnT升高的较高三分位数患者中观察到分级死亡风险，但在hs-cTnT低于参考上限的患者中未观察到。
结论
在接受择期经皮冠状动脉介入治疗的SCAD患者中，四分之一患者存在术前hs-cTnT升高。术前hs-cTnT水平升高与死亡风险成比例相关，并成为1年内全因死亡率的独立预测因素。
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