Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts; Baim Institute for Clinical Research, Boston, Massachusetts.
Duke Center for Applied Genomics and Precision Medicine, Durham, North Carolina.
JACC Cardiovasc Imaging. 2019 Jun;12(6):1047-1055. doi: 10.1016/j.jcmg.2018.01.021. Epub 2018 Mar 14.
The goal of this study was to examine associations between concentrations of high-sensitivity troponin I (hsTnI) (measured by using a single-molecule counting method) and obstructive coronary artery disease (CAD) in 1,844 stable, symptomatic outpatients with suspected CAD randomized to undergo coronary computed tomography angiography (CTA) in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial.
Elevated concentrations of hsTnI are associated with CAD in patients with myocardial infarction. The meaning of hsTnI concentrations in stable symptomatic outpatients is not well understood.
Clinical characteristics and CTA results (including coronary artery calcium [CAC] scores) were expressed across hsTnI quartiles. Determinants of hsTnI concentration were identified. Multivariable logistic regression identified independent predictors of obstructive CAD (≥50% stenosis in any vessel) and CAD (≥70% stenosis or ≥50% left main).
The median hsTnI concentration was 1.5 ng/l; nearly all (98.5%) subjects had measurable hsTnI, and 6.1% had concentrations ≥99th percentile concentration for this assay (6 ng/l). Higher CAC scores, as well as more prevalent and diffuse CAD, was seen in upper hsTnI quartiles (all p < 0.001). Independent predictors of hsTnI concentrations included age, sex, and CAC score (all p < 0.05). After adjusting for demographic and clinical characteristics, log-transformed hsTnI concentrations were associated with obstructive CAD (odds ratio: 1.15 per interquartile range; p = 0.02) and CAD (odds ratio: 1.25 per interquartile range; p = 0.001).
In stable symptomatic outpatients undergoing nonemergent coronary CTA for the diagnosis of suspected CAD, higher concentrations of hsTnI were associated with increasing presence and severity of coronary atherosclerosis. (Prospective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550).
本研究旨在探讨在 1844 例疑似冠心病的稳定型有症状门诊患者中，使用单分子计数法检测高敏肌钙蛋白 I（hsTnI）浓度与阻塞性冠状动脉疾病（CAD）之间的相关性，这些患者被随机分配行冠状动脉计算机断层扫描血管造影（CTA）检查。
在心肌梗死患者中，hsTnI 浓度升高与 CAD 相关。hsTnI 浓度在稳定型有症状的门诊患者中的意义尚不清楚。
用 hsTnI 四分位数表示临床特征和 CTA 结果（包括冠状动脉钙评分）。确定 hsTnI 浓度的决定因素。多变量逻辑回归确定阻塞性 CAD（任何血管≥50%狭窄）和 CAD（≥70%狭窄或≥50%左主干）的独立预测因子。
中位 hsTnI 浓度为 1.5ng/L；几乎所有（98.5%）患者都有可测量的 hsTnI，6.1%的患者浓度超过该检测方法的第 99 百分位数（6ng/L）。hsTnI 四分位较高者的 CAC 评分更高，且 CAD 更为普遍且更弥漫（均 p<0.001）。hsTnI 浓度的独立预测因子包括年龄、性别和 CAC 评分（均 p<0.05）。在调整人口统计学和临床特征后，log 转换后的 hsTnI 浓度与阻塞性 CAD（优势比：每四分位间距增加 1.15；p=0.02）和 CAD（优势比：每四分位间距增加 1.25；p=0.001）相关。
在因疑似冠心病而行非紧急冠状动脉 CTA 检查的稳定型有症状门诊患者中，hsTnI 浓度较高与冠状动脉粥样硬化的存在和严重程度增加相关。（前瞻性多中心胸痛评估影像学研究[PROMISE]；NCT01174550）
