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前壁ST段抬高型急性心肌梗死患者左心室质量与梗死面积的关系(来自EMBRACE STEMI临床试验)

Relation of Left Ventricular Mass and Infarct Size in Anterior Wall ST-Segment Elevation Acute Myocardial Infarction (from the EMBRACE STEMI Clinical Trial).

作者信息

Daaboul Yazan, Korjian Serge, Weaver W Douglas, Kloner Robert A, Giugliano Robert P, Carr Jim, Neal Brandon J, Chi Gerald, Cochet Madeleine, Goodell Laura, Michalak Nathan, Rusowicz-Orazem Luke, Alkathery Turky, Allaham Haytham, Routray Sujit, Szlosek Donald, Jain Purva, Gibson C Michael

机构信息

PERFUSE Study Group, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Division of Cardiology, Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan.

出版信息

Am J Cardiol. 2016 Sep 1;118(5):625-31. doi: 10.1016/j.amjcard.2016.06.025. Epub 2016 Jun 15.

Abstract

Biomarker measures of infarct size and myocardial salvage index (MSI) are important surrogate measures of clinical outcomes after a myocardial infarction. However, there is variability in infarct size unaccounted for by conventional adjustment factors. This post hoc analysis of Evaluation of Myocardial Effects of Bendavia for Reducing Reperfusion Injury in Patients With Acute Coronary Events (EMBRACE) ST-Segment Elevation Myocardial Infarction (STEMI) trial evaluates the association between left ventricular (LV) mass and infarct size as assessed by areas under the curve for creatine kinase-MB (CK-MB) and troponin I release over the first 72 hours (CK-MB area under the curve [AUC] and troponin I [TnI] AUC) and the MSI. Patients with first anterior STEMI, occluded left anterior descending artery, and available LV mass measurement in EMBRACE STEMI trial were included (n = 100) (ClinicalTrials.govNCT01572909). MSI, end-diastolic LV mass on day 4 cardiac magnetic resonance, and CK-MB and troponin I concentrations were evaluated by a core laboratory. After saturated multivariate analysis, dominance analysis was performed to estimate the contribution of each independent variable to the predicted variance of each outcome. In multivariate models that included age, gender, body surface area, lesion location, smoking, and ischemia time, LV mass remained independently associated with biomarker measures of infarct size (CK-MB AUC p = 0.02, TnI AUC p = 0.03) and MSI (p = 0.003). Dominance analysis demonstrated that LV mass accounted for 58%, 47%, and 60% of the predicted variances for CK-MB AUC, TnI AUC, and MSI, respectively. In conclusion, LV mass accounts for approximately half of the predicted variance in biomarker measures of infarct size. It should be considered as an adjustment variable in studies evaluating infarct size.

摘要

梗死面积和心肌挽救指数(MSI)的生物标志物测量是心肌梗死后临床结局的重要替代指标。然而,传统的调整因素无法解释梗死面积的变异性。这项对急性冠状动脉事件患者中苯达维对减少再灌注损伤的心肌效应评估(EMBRACE)ST段抬高型心肌梗死(STEMI)试验的事后分析,评估了左心室(LV)质量与梗死面积之间的关联,梗死面积通过肌酸激酶-MB(CK-MB)曲线下面积和肌钙蛋白I在最初72小时内的释放量(CK-MB曲线下面积[AUC]和肌钙蛋白I [TnI] AUC)以及MSI来评估。纳入了EMBRACE STEMI试验中首次发生前壁STEMI、左前降支动脉闭塞且有可用LV质量测量值的患者(n = 100)(ClinicalTrials.govNCT01572909)。由一个核心实验室评估MSI、第4天心脏磁共振成像时的舒张末期LV质量以及CK-MB和肌钙蛋白I浓度。在饱和多变量分析之后,进行优势分析以估计每个自变量对每个结局预测方差的贡献。在包含年龄、性别、体表面积、病变位置、吸烟和缺血时间的多变量模型中,LV质量仍然与梗死面积的生物标志物测量值(CK-MB AUC p = 0.02,TnI AUC p = 0.03)和MSI(p = 0.003)独立相关。优势分析表明,LV质量分别占CK-MB AUC、TnI AUC和MSI预测方差的58%、47%和60%。总之,LV质量约占梗死面积生物标志物测量值预测方差的一半。在评估梗死面积的研究中应将其视为一个调整变量。

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