Deutsches Herzzentrum München, Technische Universität München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Technische Universität München, Germany.
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
Int J Cardiol. 2018 Jan 1;250:247-252. doi: 10.1016/j.ijcard.2017.08.062.
High-sensitivity Troponins (hs-cTnT and hs-cTnI) are established biomarkers to identify patients with an acute myocardial infarction. However, data comparing the capacity of these two subtypes in predicting recurrent cardiovascular disease (CVD) events in a population with stable coronary heart disease (CHD) after adjustment for several other modern biomarkers are lacking.
We measured both troponins at baseline in 1068 CHD patients, followed them for 13years, assessed a combined CVD endpoint, and adjusted for multiple traditional and novel risk factors.
Both troponins correlated significantly with age, low and high BMI, male gender, statin therapy, and emerging biomarkers (e.g. cystatin C, NT-proBNP, GDF-15, hsCRP or galectin 3). During follow-up of 13years, 267 fatal and non-fatal CVD events occurred. Top quartiles of both troponin concentrations were significantly associated with CVD events compared to the bottom quartile after adjustment for age, gender and established CVD risk factors (hs-cTnT: hazard ratio (HR) 2.54 (95% CI, 1.60-4.03), p for trend: <0.0001; hs-cTnI: HR 2.20 (95% CI, 1.44-3.36), p for trend: <0.0002 and 0.0003). However, after adjustment for other emerging biomarkers, the associations were no longer statistically significant (hs-cTnT: HR 1.63 (95% CI, 0.97-2.73), p for trend: 0.17; hs-cTnI: HR 1.61 (95% CI, 1.00-2.60), p for trend: 0.067).
Both troponins are reliable biomarkers of recurrent cardiovascular events, especially if other novel, important markers such as NT-proBNP, GDF-15 and galectin 3 are not available. Nevertheless, a further workup is still needed to explain the complex interaction of biomarkers indicating vascular and myocardial function.
高敏肌钙蛋白（hs-cTnT 和 hs-cTnI）是识别急性心肌梗死患者的既定生物标志物。然而，在调整了其他几种现代生物标志物后，缺乏比较这两种亚型在稳定型冠心病患者中预测复发性心血管疾病（CVD）事件能力的数据。
我们在 1068 例 CHD 患者的基线时测量了这两种肌钙蛋白，随访 13 年，评估了复合 CVD 终点，并调整了多种传统和新型危险因素。
两种肌钙蛋白与年龄、低和高 BMI、男性、他汀类药物治疗以及新兴生物标志物（如胱抑素 C、NT-proBNP、GDF-15、hsCRP 或半乳糖凝集素 3）显著相关。在 13 年的随访期间，发生了 267 例致命和非致命的 CVD 事件。与最低四分位数相比，两种肌钙蛋白浓度的最高四分位数与 CVD 事件显著相关，在调整年龄、性别和已确立的 CVD 危险因素后（hs-cTnT：风险比（HR）2.54（95%CI，1.60-4.03），p 趋势<0.0001；hs-cTnI：HR 2.20（95%CI，1.44-3.36），p 趋势<0.0002 和 0.0003）。然而，在调整其他新兴生物标志物后，关联不再具有统计学意义（hs-cTnT：HR 1.63（95%CI，0.97-2.73），p 趋势：0.17；hs-cTnI：HR 1.61（95%CI，1.00-2.60），p 趋势：0.067）。
两种肌钙蛋白都是复发性心血管事件的可靠生物标志物，特别是在无法获得 NT-proBNP、GDF-15 和半乳糖凝集素 3 等其他新型重要标志物的情况下。然而，仍需要进一步检查以解释表明血管和心肌功能的生物标志物的复杂相互作用。
