Hartman Minke H T, Eppinga Ruben N, Vlaar Pieter J J, Lexis Chris P H, Lipsic Erik, Haeck Joost D E, van Veldhuisen Dirk J, van der Horst Iwan C C, van der Harst Pim
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Cardiology, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands.
Clin Cardiol. 2017 May;40(5):322-328. doi: 10.1002/clc.22663. Epub 2016 Dec 27.
Complex multimarker approaches to predict outcome after ST-elevation myocardial infarction (STEMI) have only considered a single baseline sample, while neglecting easily obtainable peak creatine kinase and creatine kinase-MB (CK-MB) values during hospitalization.
We studied 476 patients undergoing primary percutaneous coronary intervention for STEMI and cardiac magnetic resonance imaging (CMRI) at 4-6 months after STEMI. We determined the association with cardiac biomarkers (peak CK-MB, peak troponin T, N-terminal pro-brain natriuretic peptide), clinical and angiographic characteristics with infarct size, and LVEF, followed by association with mortality in 1120 STEMI patients.
Peak CK-MB was the strongest predictor for infarct size (P<0.001, R =0.60) and LVEF (P<0.001, R =0.40). The additional value of clinical and angiographic characteristics was limited. The optimal peak CK-MB cutpoints, for differentiation among small (<10% of the left ventricle), moderate (≥10%-<30%), and large infarct size (≥30%), were 210 U/L and 380 U/L, respectively. These cutpoints were associated with 90-day mortality; the hazard ratio for moderate infarct was 2.99 (95% confidence interval [CI]: 1.51-5.93, P=0.002) and for large infarct 6.53 (95% CI: 3.63-11.76, P<0.001).
Classical peak CK-MB measured during hospitalization for STEMI was superior to other clinical and angiographic characteristics in predicting CMRI-defined infarct size and LVEF, and should be included and validated in future multimarker studies. Peak CK-MB cutpoints differentiated among infarct size categories and were associated with increased 90-day mortality risk.
用于预测ST段抬高型心肌梗死（STEMI）后结局的复杂多标志物方法仅考虑了单个基线样本，却忽略了住院期间易于获取的肌酸激酶峰值和肌酸激酶同工酶（CK-MB）值。
我们研究了476例接受STEMI直接经皮冠状动脉介入治疗并在STEMI后4至6个月进行心脏磁共振成像（CMRI）的患者。我们确定了心脏生物标志物（CK-MB峰值、肌钙蛋白T峰值、N末端脑钠肽前体）、临床和血管造影特征与梗死面积及左心室射血分数（LVEF）之间的关联，随后在1120例STEMI患者中确定了这些因素与死亡率的关联。
CK-MB峰值是梗死面积（P<0.001，R =0.60）和LVEF（P<0.001，R =0.40）的最强预测指标。临床和血管造影特征的附加价值有限。区分小面积（<左心室的10%）、中等面积（≥10% - <30%）和大面积梗死（≥30%）的最佳CK-MB峰值切点分别为210 U/L和380 U/L。这些切点与90天死亡率相关；中等面积梗死的风险比为2.99（95%置信区间[CI]：1.51 - 5.93，P =0.002），大面积梗死的风险比为6.53（95%CI：3.63 - 11.76，P<0.001）。
STEMI住院期间测量的经典CK-MB峰值在预测CMRI定义的梗死面积和LVEF方面优于其他临床和血管造影特征，应纳入未来的多标志物研究并进行验证。CK-MB峰值切点可区分梗死面积类别，并与90天死亡风险增加相关。
