非ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后肌酸激酶心肌带和高敏肌钙蛋白T的比较预后价值
Comparative prognostic value of postprocedural creatine kinase myocardial band and high-sensitivity troponin T in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention.
作者信息
Ndrepepa Gjin, Colleran Roisin, Braun Siegmund, Xhepa Erion, Hieber Julia, Cassese Salvatore, Fusaro Massimiliano, Kufner Sebastian, Laugwitz Karl-Ludwig, Schunkert Heribert, Kastrati Adnan
机构信息
Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
Department of Laboratory Medicine, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
出版信息
Catheter Cardiovasc Interv. 2018 Feb 1;91(2):215-223. doi: 10.1002/ccd.27105. Epub 2017 May 13.
OBJECTIVES
We aimed to assess the prognostic value of postprocedural creatine kinase myocardial band (CK-MB) and cardiac troponin (cTn) in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
BACKGROUND
Whether postprocedural CK-MB or cTn is a better biomarker to stratify the risk after percutaneous coronary intervention (PCI) remains unknown.
METHODS
This study included 2,077 patients with NSTEMI undergoing early PCI. Peak postprocedural values of CK-MB and high-sensitivity cTn T (hs-cTnT) were analyzed. The primary outcome was 3-year mortality.
RESULTS
The median values of peak postprocedural CK-MB and hs-cTnT were 18.3 U L and 0.140 µg L , respectively. Overall, 211 patients died during follow-up. There were 129 deaths in patients with CK-MB >the median value and 82 deaths in those with CK-MB ≤the median value (Kaplan-Meier estimates of 3-year mortality, 18.9% and 14.0%, respectively; hazard ratio [HR] = 1.52, 95% confidence interval [CI] 1.16-2.01; P < 0.001). There were 134 deaths in patients with hs-cTnT >the median value and 77 deaths in patients with hs-cTnT ≤the median value (Kaplan-Meier estimates of 3-year mortality, 19.9% and 13.2%, respectively; HR = 1.90 [1.44-2.52]; P < 0.001). After adjustment, peak postprocedural CK-MB (adjusted HR = 1.05 [1.02-1.07], P < 0.001 for each 24 U L increment) and hs-cTnT (adjusted HR = 1.12 [1.01-1.25], P = 0.037 for each unit higher log hs-cTnT) remained independently associated with the risk of 3-year mortality. The C-statistic(s) of the model with CK-MB and hs-cTnT were 0.789 [0.757-0.817] and 0.793 [0.762-0.821], respectively (P = 0.585).
CONCLUSION
In patients with NSTEMI undergoing early PCI, peak postprocedural CK-MB and hs-cTnT are independently associated with the risk of 3-year mortality. © 2017 Wiley Periodicals, Inc.
目的
我们旨在评估非ST段抬高型心肌梗死（NSTEMI）患者术后肌酸激酶心肌带（CK-MB）和心肌肌钙蛋白（cTn）的预后价值。
背景
术后CK-MB或cTn是否是经皮冠状动脉介入治疗（PCI）后更好的风险分层生物标志物仍不清楚。
方法
本研究纳入了2077例接受早期PCI的NSTEMI患者。分析术后CK-MB和高敏肌钙蛋白T（hs-cTnT）的峰值。主要结局是3年死亡率。
结果
术后CK-MB和hs-cTnT峰值的中位数分别为18.3 U/L和0.140 μg/L。总体而言，211例患者在随访期间死亡。CK-MB>中位数的患者中有129例死亡，CK-MB≤中位数的患者中有82例死亡（Kaplan-Meier估计的3年死亡率分别为18.9%和14.0%；风险比[HR]=1.52，95%置信区间[CI] 1.16-2.01；P<0.001）。hs-cTnT>中位数的患者中有134例死亡，hs-cTnT≤中位数的患者中有77例死亡（Kaplan-Meier估计的3年死亡率分别为19.9%和13.2%；HR=1.90[1.44-2.52]；P<0.001）。调整后，术后CK-MB峰值（调整后HR=1.05[1.02-1.07]，每增加24 U/L，P<0.001）和hs-cTnT（调整后HR=1.12[1.01-1.25]，hs-cTnT每升高一个对数单位，P=0.037）仍与3年死亡风险独立相关。包含CK-MB和hs-cTnT的模型的C统计量分别为0.789[0.757-0.817]和0.793[0.762-0.821]（P=0.585）。
结论
在接受早期PCI的NSTEMI患者中，术后CK-MB和hs-cTnT峰值与3年死亡风险独立相关。©2017威利期刊公司。
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