Xiao Wenkai, Cao Ruihua, Liu Yuan, Wang Fan, Bai Yongyi, Wu Hongmei, Ye Ping
Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China.
BMJ Open. 2017 Jun 26;7(6):e013431. doi: 10.1136/bmjopen-2016-013431.
The prognostic value of cardiac troponins in apparently healthy populations is not well established. The aim of this study was to investigate the prognostic properties of high-sensitivity cardiac troponin T (hs-cTnT) for long-term adverse outcomes.
A community-dwelling prospective survey of residents from two communities in Beijing.
From September 2007 to January 2009, 1680 participants were initially enrolled. Of these, 1499 (870 females, mean age: 61.4 years) participants completed the survey and were followed up for a median of 4.8 years (IQR: 4.5-5.2).
The primary outcome was the occurrence of all-cause mortality and major cardiovascular events.
Overall, 820 individuals (54.7%) had detectable hs-cTnT levels. During the follow-up, 52 participants (3.5%) died, 154 (10.3%) had major cardiovascular events and 99 (6.6%) experienced new-onset coronary events. Compared with those with undetectable hs-cTnT levels, participants with hs-cTnT levels in the highest category (≥14 ng/L) had a significantly increased risk for all-cause mortality (adjusted HR (aHR): 2.07, 95% CI 1.05 to 3.01), major cardiovascular events (aHR: 3.27, 95% CI 1.88 to 5.70) and coronary events (aHR: 4.50, 95% CI 2.26 to 9.02) in covariate-adjusted analyses. No differences in stroke incidence were found (aHR: 1.27, 95% CI 0.69 to 2.62). Also, significant associations were presented when hs-cTnT levels were modelled as a continuous variable and when analysing changes in hs-cTnT levels over time with adverse outcomes. The addition of troponin T levels to clinical variables led to significant increases in risk prediction with a marked improvement in the C-statistics (p=0.003 or lower).
In this cohort of individuals from a community-based population, cTnT levels measured with a highly sensitive assay were associated with increases in the subsequent risk for all-cause mortality and major cardiovascular events. These results might support screening for at-risk individuals.
心肌肌钙蛋白在表面健康人群中的预后价值尚未明确确立。本研究的目的是调查高敏心肌肌钙蛋白T（hs-cTnT）对长期不良结局的预后特性。
对北京两个社区居民进行的社区居住前瞻性调查。
2007年9月至2009年1月，最初招募了1680名参与者。其中，1499名（870名女性，平均年龄：61.4岁）参与者完成了调查，并进行了中位数为4.8年（四分位间距：4.5 - 5.2）的随访。
主要结局是全因死亡率和主要心血管事件的发生。
总体而言，820人（54.7%）hs-cTnT水平可检测到。在随访期间，52名参与者（3.5%）死亡，154名（10.3%）发生主要心血管事件，99名（6.6%）发生新发冠心病事件。与hs-cTnT水平不可检测的参与者相比，hs-cTnT水平处于最高类别（≥14 ng/L）的参与者在协变量调整分析中全因死亡率（调整后风险比（aHR）：2.07，95%置信区间1.05至3.01）、主要心血管事件（aHR：3.27，95%置信区间1.88至5.70）和冠心病事件（aHR：4.50，95%置信区间2.26至9.02）的风险显著增加。未发现中风发病率有差异（aHR：1.27，95%置信区间0.69至2.62）。此外，当将hs-cTnT水平作为连续变量建模以及分析hs-cTnT水平随时间变化与不良结局的关系时，也呈现出显著关联。将肌钙蛋白T水平添加到临床变量中导致风险预测显著增加，C统计量有明显改善（p = 0.003或更低）。
在这个基于社区人群的队列中，用高敏检测法测量的cTnT水平与随后全因死亡率和主要心血管事件风险的增加相关。这些结果可能支持对高危个体进行筛查。
