高敏心肌肌钙蛋白I与疑似心绞痛患者冠状动脉疾病的诊断
High-Sensitivity Cardiac Troponin I and the Diagnosis of Coronary Artery Disease in Patients With Suspected Angina Pectoris.
作者信息
Adamson Philip D, Hunter Amanda, Madsen Debbie M, Shah Anoop S V, McAllister David A, Pawade Tania A, Williams Michelle C, Berry Colin, Boon Nicholas A, Flather Marcus, Forbes John, McLean Scott, Roditi Giles, Timmis Adam D, van Beek Edwin J R, Dweck Marc R, Mickley Hans, Mills Nicholas L, Newby David E
机构信息
From the British Heart Foundation Centre for Cardiovascular Science (P.D.A., A.H., A.S.V.S., T.A.P., N.A.B., E.J.R.v.B., M.R.D., N.L.M., D.E.N.) and Clinical Research Imaging Centre (M.C.W.), University of Edinburgh, United Kingdom; Department of Cardiology, Odense University Hospital, Denmark (D.M.M., H.M.); Institute of Health and Wellbeing (D.A.M.) and Institute of Clinical Sciences (C.B., G.R.), University of Glasgow, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom (M.F.); Health Research Institute, University of Limerick, Ireland (J.F.); National Health Service, Fife, United Kingdom (S.M.); and William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.D.T.).
出版信息
Circ Cardiovasc Qual Outcomes. 2018 Feb;11(2):e004227. doi: 10.1161/CIRCOUTCOMES.117.004227.
BACKGROUND
We determined whether high-sensitivity cardiac troponin I can improve the estimation of the pretest probability for obstructive coronary artery disease (CAD) in patients with suspected stable angina.
METHODS AND RESULTS
In a prespecified substudy of the SCOT-HEART trial (Scottish Computed Tomography of the Heart), plasma cardiac troponin was measured using a high-sensitivity single-molecule counting assay in 943 adults with suspected stable angina who had undergone coronary computed tomographic angiography. Rates of obstructive CAD were compared with the pretest probability determined by the CAD Consortium risk model with and without cardiac troponin concentrations. External validation was undertaken in an independent study population from Denmark comprising 487 patients with suspected stable angina. Higher cardiac troponin concentrations were associated with obstructive CAD with a 5-fold increase across quintiles (9%-48%; <0.001) independent of known cardiovascular risk factors (odds ratio, 1.35; 95% confidence interval, 1.25-1.46 per doubling of troponin). Cardiac troponin concentrations improved the discrimination and calibration of the CAD Consortium model for identifying obstructive CAD (C statistic, 0.788-0.800; =0.004; χ=16.8 [=0.032] to 14.3 [=0.074]). The updated model also improved classification of the American College of Cardiology/American Heart Association pretest probability risk categories (net reclassification improvement, 0.062; 95% confidence interval, 0.035-0.089). The revised model achieved similar improvements in discrimination and calibration when applied in the external validation cohort.
CONCLUSIONS
High-sensitivity cardiac troponin I concentration is an independent predictor of obstructive CAD in patients with suspected stable angina. Use of this test may improve the selection of patients for further investigation and treatment.
CLINICAL TRIAL REGISTRATION
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01149590.
背景
我们确定了高敏心肌肌钙蛋白I是否能改善疑似稳定型心绞痛患者阻塞性冠状动脉疾病（CAD）的验前概率估计。
方法与结果
在SCOT-HEART试验（苏格兰心脏计算机断层扫描）的一项预先指定的亚研究中，使用高敏单分子计数法对943例接受冠状动脉计算机断层血管造影的疑似稳定型心绞痛成人患者测量血浆心肌肌钙蛋白。将阻塞性CAD的发生率与由CAD联盟风险模型确定的有无心肌肌钙蛋白浓度时的验前概率进行比较。在来自丹麦的一个包含487例疑似稳定型心绞痛患者的独立研究人群中进行了外部验证。较高的心肌肌钙蛋白浓度与阻塞性CAD相关，五分位数间增加了5倍（9% - 48%；P<0.001），独立于已知的心血管危险因素（比值比，1.35；95%置信区间，每肌钙蛋白翻倍为1.25 - 1.46）。心肌肌钙蛋白浓度改善了CAD联盟模型对识别阻塞性CAD的辨别能力和校准（C统计量，0.788 - 0.800；P = 0.004；χ² = 16.8 [P = 0.032]至14.3 [P = 0.074]）。更新后的模型还改善了美国心脏病学会/美国心脏协会验前概率风险类别的分类（净重新分类改善，0.062；95%置信区间，0.035 - 0.089）。当应用于外部验证队列时，修订后的模型在辨别能力和校准方面取得了类似的改善。
结论
高敏心肌肌钙蛋白I浓度是疑似稳定型心绞痛患者阻塞性CAD的独立预测因子。使用该检测可能会改善对患者进行进一步检查和治疗的选择。
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