高敏心肌肌钙蛋白 T 与 ST 段抬高型心肌梗死患者的预后。

High-sensitivity cardiac troponin T and prognosis in patients with ST-segment elevation myocardial infarction.

机构信息

Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.

出版信息

J Cardiol. 2018 Sep;72(3):220-226. doi: 10.1016/j.jjcc.2018.02.014. Epub 2018 Mar 26.

DOI:10.1016/j.jjcc.2018.02.014

PMID:29599097

Abstract

BACKGROUND

Evidence on the use of high-sensitivity cardiac troponins (hs-cTn) to risk-stratify patients with ST-segment elevation myocardial infarction (STEMI) is limited.

METHODS

We assessed the prognostic value of preprocedural (admission) and peak postprocedural hs-cTnT in 818 patients with STEMI treated with primary percutaneous coronary intervention (PPCI). Preprocedural and peak postprocedural hs-cTnT was measured. The primary outcome was 3-year all-cause mortality.

RESULTS

The median values of preprocedural and peak postprocedural hs-cTnT were 153ng/L and 1980ng/L. Overall, 134 patients died during the follow-up. There were 85 deaths in patients with preprocedural hs-cTnT >median value and 49 deaths in patients with preprocedural hs-cTnT ≤median value [Kaplan-Meier estimates of mortality, 22.2% and 13.5%; unadjusted hazard ratio (HR)=1.88, 95% confidence interval (CI) 1.32-2.67, p<0.001]. According to peak postprocedural hs-cTnT, there were 84 deaths in patients with postprocedural hs-cTnT >median value and 50 deaths in patients with postprocedural hs-cTnT ≤median value [Kaplan-Meier estimates of mortality, 22.3% and 13.4%; unadjusted HR=1.82 (1.28-2.59), p<0.001]. After adjustment, preprocedural [adjusted HR=1.08 (1.03-1.12), p<0.001] and peak postprocedural hs-cTnT value [adjusted HR=1.06 (1.04-1.08), p<0.001] were independently associated with 3-year mortality (with risk estimates calculated per 70×99th upper reference limit of hs-cTnT). The C statistic of multivariable model increased from 0.868 (0.841-0.895) to 0.872 (0.845-0.898) after incorporation of preprocedural hs-cTnT (p=0.050) and to 0.874 (0.846-0.899) after incorporation of the postprocedural hs-cTnT into the model (p=0.035).

CONCLUSIONS

In conclusion, admission or peak postprocedural hs-cTnT is independently associated with the risk for 3-year mortality in patients with STEMI undergoing PPCI.

摘要

背景

关于高敏心肌肌钙蛋白（hs-cTn）用于 ST 段抬高型心肌梗死（STEMI）患者风险分层的证据有限。

方法

我们评估了 818 例接受直接经皮冠状动脉介入治疗（PPCI）的 STEMI 患者的术前（入院时）和术后 hs-cTnT 峰值的预后价值。测量了术前和术后 hs-cTnT 的值。主要结局是 3 年全因死亡率。

结果

术前和术后 hs-cTnT 的中位数分别为 153ng/L 和 1980ng/L。随访期间共有 134 例患者死亡。术前 hs-cTnT 值>中位数的患者有 85 例死亡，术前 hs-cTnT 值≤中位数的患者有 49 例死亡[死亡率的 Kaplan-Meier 估计值，22.2%和 13.5%；未调整的危险比（HR）=1.88，95%置信区间（CI）1.32-2.67，p<0.001]。根据术后 hs-cTnT 值，术后 hs-cTnT 值>中位数的患者有 84 例死亡，术后 hs-cTnT 值≤中位数的患者有 50 例死亡[死亡率的 Kaplan-Meier 估计值，22.3%和 13.4%；未调整的 HR=1.82（1.28-2.59），p<0.001]。调整后，术前[调整后的 HR=1.08（1.03-1.12），p<0.001]和术后 hs-cTnT 值[调整后的 HR=1.06（1.04-1.08），p<0.001]与 3 年死亡率独立相关（每 70×99 上参考限值增加 1 个 hs-cTnT 的风险估计）。多变量模型的 C 统计量从 0.868（0.841-0.895）增加到纳入术前 hs-cTnT 后为 0.872（0.845-0.898）（p=0.050），纳入术后 hs-cTnT 后为 0.874（0.846-0.899）（p=0.035）。