新型肌钙蛋白在现代 ST 段抬高型心肌梗死中的预后价值：RUTI-STEMI 研究。
Prognostic Value of New-Generation Troponins in ST-Segment-Elevation Myocardial Infarction in the Modern Era: The RUTI-STEMI Study.
机构信息
Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain.
Department of Medicine, CIBERCV Autonomous University of Barcelona, Spain.
出版信息
J Am Heart Assoc. 2017 Dec 23;6(12):e007252. doi: 10.1161/JAHA.117.007252.
BACKGROUND
In ST-segment-elevation myocardial infarction (STEMI), troponins are not needed for diagnosis: symptoms and ECG data are sufficient to activate percutaneous coronary intervention. This study explored the prognostic value of new-generation troponins in a real-life cohort contemporarily treated for STEMI.
METHODS AND RESULTS
We studied 1260 consecutive patients with primary STEMI treated with percutaneous coronary intervention between February 22, 2011, and August 31, 2015. We collected data on clinical characteristics and major adverse cardiovascular and cerebrovascular events (MACCEs) at 30 days and 1 year. Peak high-sensitivity troponin T and sensitive-contemporary troponin I levels were recorded. MACCEs occurred in 75 patients (6.1%) by day 30 and in 124 patients (10.8%) between day 31 and 1 year. A short-term (0-30 days) multivariable Cox regression analysis revealed that age, Killip-Kimball class, and left ventricular ejection fraction were independent predictors of MACCEs. In adjusted analysis, peak high-sensitivity troponin T and sensitive-contemporary troponin I were not significant (hazard ratio, 1.23 [95% confidence interval, 0.98-1.54] [=0.071]; and hazard ratio, 1.15 [95% confidence interval, 0.93-1.43] [=0.200], respectively). A long-term (31 days-1 year) multivariable Cox regression analysis revealed that age, female sex, diabetes mellitus, prior coronary artery disease, Killip-Kimball class, and left ventricular ejection fraction were statistically significantly associated with MACCEs. However, peak high-sensitivity troponin T and peak sensitive-contemporary troponin I were not significantly associated with MACCEs (hazard ratio, 1.03 [95% confidence interval, 0.88-1.20] [=0.715]; and hazard ratio, 0.99 [95% confidence interval, 0.85-1.15] [=0.856], respectively).
CONCLUSIONS
In the modern era, new-generation troponins do not provide significant prognostic information for predicting clinical events in STEMI. We should reconsider the value of serial troponin measurements for risk stratification in STEMI.
背景
在 ST 段抬高型心肌梗死（STEMI）中，诊断不需要肌钙蛋白：症状和心电图数据足以激活经皮冠状动脉介入治疗。本研究旨在探讨新一代肌钙蛋白在当代接受 STEMI 治疗的真实队列中的预后价值。
方法和结果
我们研究了 2011 年 2 月 22 日至 2015 年 8 月 31 日期间接受经皮冠状动脉介入治疗的 1260 例连续原发性 STEMI 患者。我们收集了 30 天和 1 年时的临床特征和主要不良心血管和脑血管事件（MACCE）数据。记录了峰值高敏肌钙蛋白 T 和敏感的即时肌钙蛋白 I 水平。30 天内有 75 例（6.1%）患者发生 MACCE，31 天至 1 年内有 124 例（10.8%）患者发生 MACCE。短期（0-30 天）多变量 Cox 回归分析显示，年龄、Killip-Kimball 分级和左心室射血分数是 MACCE 的独立预测因素。在调整分析中，峰值高敏肌钙蛋白 T 和敏感即时肌钙蛋白 I 无显著意义（风险比，1.23[95%置信区间，0.98-1.54]，=0.071；和风险比，1.15[95%置信区间，0.93-1.43]，=0.200）。长期（31 天-1 年）多变量 Cox 回归分析显示，年龄、女性、糖尿病、既往冠状动脉疾病、Killip-Kimball 分级和左心室射血分数与 MACCE 显著相关。然而，峰值高敏肌钙蛋白 T 和峰值敏感即时肌钙蛋白 I 与 MACCE 无显著相关性（风险比，1.03[95%置信区间，0.88-1.20]，=0.715；和风险比，0.99[95%置信区间，0.85-1.15]，=0.856）。
结论
在现代，新一代肌钙蛋白并不能为预测 STEMI 临床事件提供显著的预后信息。我们应该重新考虑连续肌钙蛋白测量在 STEMI 风险分层中的价值。
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