Cardiovascular Research Unit, Craigavon Cardiac Centre, Craigavon Area Hospital, Southern Trust, N Ireland BT63 5QQ, UK.
Research and Development Department, Randox Laboratories Ltd, Crumlin, N Ireland BT29 4QY, UK.
QJM. 2018 Jan 1;111(1):33-38. doi: 10.1093/qjmed/hcx193.
BACKGROUND/INTRODUCTION: Type 4a myocardial infarction (MI) occurs when myocardial injury is combined with either symptoms suggestive of myocardial ischaemia, new left bundle branch block, angiographic loss of patency of a major artery or imaging suggestive of new loss of myocardium. Myocardial injury is defined as a rise of >5 x 99th upper reference limit (URL) of 14 ng/l (i.e. >70 ng/l) for highly sensitive troponin T (hsTnT) at 6 h if hsTnT was normal at baseline or >20% rise from 0 to 6 h if hsTnT was >14 ng/l at baseline.
To assess the prognostic value of biomarkers of myocardial injury following elective percutaneous coronary intervention (PCI).
A cohort of 209 patients were included of whom 144 (68.9%) were male, mean age was 68.8 years, 28 (13.4%) were smokers, 31 (14.8%) were diabetic, 199 (95.2%) had hypercholesterolaemia and 138 (66.0%) had hypertension.
We evaluated hsTnT, heart-type fatty acid-binding protein (H-FABP), troponin I (TnI), creatine kinase MB type (CKMB), myoglobin, glycogen phosphorylase BB (GPBB) and carbonic anhydrase III (CA III) at 0, 4, 6 and 24 h following elective PCI. Patients were followed up at 1 year to assess for major adverse clinical events (MACE).
Myocardial injury was observed in 37 (17.7%) patients. Median hsTnT/H-FABP at 4 h were most predictive. MACE was noted in 6 (2.9%) patients, 3 had type 4a MI post PCI, P = 0.036.
DISCUSSION/CONCLUSIONS: Median 4 h hsTnT/H-FABP were most predictive of myocardial injury following PCI. H-FABP and hsTnT were predictive of MACE.
背景/引言：当心肌损伤伴有心肌缺血的症状、新发左束支传导阻滞、主要动脉的血管造影通畅性丧失或影像学提示新的心肌丧失时，会发生 4a 型心肌梗死（MI）。心肌损伤定义为如果 hsTnT 在基线时正常，则 hsTnT 在 6 小时时升高>5 x 99 个上参考限（URL）的 14 ng/l（即>70 ng/l）；或者如果 hsTnT 在基线时>14 ng/l，则 hsTnT 在 0 至 6 小时内升高>20%。
评估选择性经皮冠状动脉介入治疗（PCI）后心肌损伤生物标志物的预后价值。
纳入了 209 例患者，其中 144 例（68.9%）为男性，平均年龄为 68.8 岁，28 例（13.4%）为吸烟者，31 例（14.8%）为糖尿病患者，199 例（95.2%）为高胆固醇血症患者，138 例（66.0%）为高血压患者。
我们在选择性 PCI 后 0、4、6 和 24 小时评估 hsTnT、心脏型脂肪酸结合蛋白（H-FABP）、肌钙蛋白 I（TnI）、肌酸激酶 MB 同工酶（CKMB）、肌红蛋白、糖原磷酸化酶 BB（GPBB）和碳酸酐酶 III（CA III）。患者在 1 年后进行随访，以评估主要不良临床事件（MACE）。
37 例（17.7%）患者出现心肌损伤。中位数 hsTnT/H-FABP 在 4 小时时最具预测性。6 例（2.9%）患者出现 MACE，其中 3 例在 PCI 后发生 4a 型 MI，P=0.036。
讨论/结论：中位数 4 小时 hsTnT/H-FABP 对 PCI 后心肌损伤最具预测性。H-FABP 和 hsTnT 对 MACE 有预测作用。
