Harada Yukinori, Koskinas Konstantinos C, Ndrepepa Gjin, Räber Lorenz, Braun Siegmund, Zanchin Thomas, Kufner Sebastian, Hunziker Lukas, Byrne Robert A, Heg Dik, Kastrati Adnan, Windecker Stephan
Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Department of Cardiology, Bern University Hospital, Switzerland.
Cardiovasc Revasc Med. 2018 Jul;19(5 Pt A):480-486. doi: 10.1016/j.carrev.2017.11.010. Epub 2017 Nov 22.
The association of postprocedural high-sensitivity troponin T (hs-TnT) with prognosis of non-ST-segment elevation myocardial infarction (NSTEMI) patients is incompletely investigated.
To assess the prognostic value of hs-TnT in NSTEMI patients undergoing early percutaneous coronary intervention (PCI).
This study included 3783 patients with NSTEMI undergoing early PCI. Preprocedural and peak postprocedural hs-TnT was measured. Patients were divided into 3 groups: a group with postprocedural hs-TnT in the 1st tertile (hs-TnT <105ng/L; n=1264), a group with postprocedural hs-TnT in the 2nd tertile (hs-TnT ≥105ng/L to 470ng/L; n=1258) and a group with postprocedural hs-TnT in the 3rd tertile (hs-TnT >470ng/L; n=1261). The primary outcome was 1-year all-cause mortality.
Overall, there were 299 deaths: 59 (5.5%), 98 (8.2%) and 142 deaths (12.6%) among patients of the 1st, 2nd and 3rd postprocedural hs-TnT tertiles (unadjusted hazard ratio [HR]=1.65, 95% confidence interval [CI] 1.20 to 2.67; P=0.002 for tertile 2 vs tertile 1 and unadjusted HR=2.41 [1.79-3.25]; P<0.001 for tertile 3 vs tertile 1). After adjustment postprocedural hs-TnT was independently associated with the risk of all-cause mortality (adjusted [HR]=1.22 [1.13-1.33], P<0.001 for 1 unit higher log hs-TnT). Postprocedural hs-TnT improved the risk prediction of the model of all-cause mortality (the C statistic of the model without [with baseline variables only] and with incorporation of postprocedural hs-TnT was 0.759 [0.732-0.782] and 0.772 [0.746-0.794], respectively; P<0.001).
In patients with NSTEMI undergoing early PCI, postprocedural hs-TnT is independently associated with increased risk of mortality up to 1year after PCI.
术后高敏肌钙蛋白T（hs-TnT）与非ST段抬高型心肌梗死（NSTEMI）患者预后的相关性研究尚不充分。
评估hs-TnT对接受早期经皮冠状动脉介入治疗（PCI）的NSTEMI患者的预后价值。
本研究纳入3783例接受早期PCI的NSTEMI患者，测定术前和术后hs-TnT峰值。患者分为3组：术后hs-TnT处于第一三分位数组（hs-TnT<105ng/L；n = 1264）、术后hs-TnT处于第二三分位数组（hs-TnT≥105ng/L至470ng/L；n = 1258）和术后hs-TnT处于第三三分位数组（hs-TnT>470ng/L；n = 1261）。主要结局为1年全因死亡率。
总体上，共有299例死亡：术后hs-TnT处于第一、第二和第三三分位数组的患者分别有59例（5.5%）、98例（8.2%）和142例死亡（12.6%）（未调整风险比[HR]=1.65，95%置信区间[CI]为1.20至2.67；第二三分位数组与第一三分位数组相比，P = 0.002，未调整HR = 2.41[1.79 - 3.25]；第三三分位数组与第一三分位数组相比，P<0.001）。调整后，术后hs-TnT与全因死亡风险独立相关（调整后[HR]=1.22[1.13 - 1.33]，hs-TnT对数每升高1个单位，P<0.001）。术后hs-TnT改善了全因死亡模型的风险预测（仅含基线变量的模型和纳入术后hs-TnT的模型的C统计量分别为0.759[0.732 - 0.782]和0.772[0.746 - 0.794]；P<0.001）。
在接受早期PCI的NSTEMI患者中，术后hs-TnT与PCI后长达1年的死亡风险增加独立相关。
