Department of Medicine, Massachusetts General Hospital, Boston, MA.
Division of Cardiology, Massachusetts General Hospital, Boston, MA.
J Am Heart Assoc. 2018 Mar 8;7(6):e007975. doi: 10.1161/JAHA.117.007975.
The meaning of high-sensitivity troponin I (hsTnI) concentrations in patients without acute myocardial infarction (MI) requires clarity. We hypothesized that among patients referred for diagnostic coronary angiography without acute MI, hsTnI concentrations would correlate with prevalent coronary artery disease (CAD) and predict incident cardiovascular events and mortality.
We measured hsTnI using a single-molecule counting assay (99th percentile, 6 ng/L) in samples from 991 patients obtained at the time of angiography. Concentrations of hsTnI were assessed relative to the severity of CAD and prognosis during mean follow-up of 3.7 years. Median hsTnI concentration was 4.19 ng/L; 38% of patients had hsTnI concentrations ≥99th percentile. Across increasing hsTnI quartiles, patients had higher prevalence of angiographic CAD; in multivariate models, hsTnI ≥99th percentile independently predicted obstructive CAD (odds ratio: 2.57; <0.001) and incident MI (hazard ratio [HR]: 2.68; <0.001), cardiovascular death (HR: 2.29; =0.001), and all-cause death (HR: 1.84; =0.004). In those with >70% coronary stenosis, hsTnI ≥99th percentile independently predicted incident MI (HR: 1.87; =0.01), cardiovascular mortality (HR: 2.74; =0.001), and the composite end point of MI and all-cause death (HR: 2.06; <0.001). In participants with coronary stenosis <70%, hsTnI ≥99th percentile even more strongly predicted incident MI (HR: 8.41; <0.001), cardiovascular mortality (HR: 3.60; =0.03), and the composite end point of MI and all-cause death (HR: 3.62; <0.001).
In a large prospective cohort of patients who were free of prevalent MI and undergoing diagnostic coronary angiography, hsTnI concentrations were associated with higher prevalence of CAD and predicted incident MI, cardiovascular death, and all-cause death.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00842868.
在没有急性心肌梗死（MI）的患者中，高敏肌钙蛋白 I（hsTnI）浓度的意义尚不清楚。我们假设，在因诊断性冠状动脉造影而就诊的无急性 MI 患者中，hsTnI 浓度与现患冠状动脉疾病（CAD）相关，并可预测心血管事件和死亡的发生。
我们在 991 例接受冠状动脉造影患者的样本中，使用单分子计数法（第 99 百分位数，6ng/L）测量 hsTnI。根据 CAD 的严重程度和平均 3.7 年的随访预后评估 hsTnI 浓度。hsTnI 浓度中位数为 4.19ng/L；38%的患者 hsTnI 浓度≥第 99 百分位数。hsTnI 四分位递增时，患者的血管造影 CAD 患病率逐渐升高；在多变量模型中，hsTnI≥第 99 百分位数独立预测阻塞性 CAD（比值比：2.57；<0.001）和新发 MI（风险比[HR]：2.68；<0.001）、心血管死亡（HR：2.29；=0.001）和全因死亡（HR：1.84；=0.004）。在存在≥70%冠状动脉狭窄的患者中，hsTnI≥第 99 百分位数独立预测新发 MI（HR：1.87；=0.01）、心血管死亡率（HR：2.74；=0.001）和 MI 和全因死亡的复合终点（HR：2.06；<0.001）。在冠状动脉狭窄<70%的患者中，hsTnI≥第 99 百分位数甚至更强烈地预测新发 MI（HR：8.41；<0.001）、心血管死亡率（HR：3.60；=0.03）和 MI 和全因死亡的复合终点（HR：3.62；<0.001）。
在一个接受诊断性冠状动脉造影且无明显 MI 的大型前瞻性队列中，hsTnI 浓度与 CAD 的患病率较高相关，并预测新发 MI、心血管死亡和全因死亡。
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