与欧洲心脏病学会风险评分（ESC-SCORE）相比，使用高敏心肌肌钙蛋白T单一生物标志物策略对稳定型心血管疾病进行风险预测。
Risk prediction in stable cardiovascular disease using a high-sensitivity cardiac troponin T single biomarker strategy compared to the ESC-SCORE.
作者信息
Biener Moritz, Giannitsis Evangelos, Kuhner Manuel, Zelniker Thomas, Mueller-Hennessen Matthias, Vafaie Mehrshad, Stoyanov Kiril M, Neumann Franz-Josef, Katus Hugo A, Hochholzer Willibald, Valina Christian Marc
机构信息
Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany.
出版信息
Open Heart. 2018 Apr 25;5(1):e000710. doi: 10.1136/openhrt-2017-000710. eCollection 2018.
OBJECTIVE
To evaluate the prognostic performance of high-sensitivity cardiac troponin T (hs-cTnT) compared with the ESC-SCORE.
METHODS
We included low-risk outpatients with stable cardiovascular (CV) disease categorised into need for non-secondary and secondary prevention. The prognostication of hs-cTnT at index visit was compared with the European Society of Cardiology-Systematic COronary Risk Evaluation (ESC-SCORE) with respect to all-cause mortality (ACM) and two composite endpoints (ACM, acute myocardial infarction (AMI) and stroke and ACM, AMI, stroke and rehospitalisation for acute coronary syndrome (ACS) and decompensated heart failure (DHF)).
RESULTS
Within a median follow-up of 796 days, a total of 16 deaths, 32 composite endpoints of ACM, AMI and stroke and 83 composite endpoints of ACM, AMI, stroke, rehospitalisation for ACS and DHF were observed among 693 stable low-risk outpatients. Using C-statistics, measurement of hs-cTnT alone outperformed the ESC-SCORE for the prediction of ACM in the entire study population (Δarea under the curve (AUC) 0.221, p=0.0039) and both prevention groups (non-secondary: ΔAUC 0.164, p=0.0208; secondary: ΔAUC 0.264, p=0.0134). For the prediction of all other secondary endpoints, hs-cTnT was at least as effective as the ESC-SCORE, both in secondary and non-secondary prevention. Using continuous and categorical net reclassification improvement and integrated discrimination improvement, hs-cTnT significantly improved reclassification regarding all endpoints in the entire population and in the secondary prevention cohort. In non-secondary prevention, hs-cTnT improved reclassification only for ACM. The results were confirmed in an independent external cohort on 2046 patients.
CONCLUSIONS
Hs-cTnT is superior to the multivariable ESC-SCORE for the prediction of ACM and a composite endpoint in stable outpatients with and without relevant CV disease.
TRIAL REGISTRATION NUMBER
NCT01954303; Pre-results.
目的
评估高敏心肌肌钙蛋白T（hs-cTnT）与欧洲心脏病学会风险评分（ESC-SCORE）相比的预后性能。
方法
我们纳入了患有稳定心血管疾病的低风险门诊患者，这些患者被分类为需要进行非二级预防和二级预防。将初次就诊时hs-cTnT的预后评估与欧洲心脏病学会系统性冠状动脉风险评估（ESC-SCORE）在全因死亡率（ACM）以及两个复合终点（ACM、急性心肌梗死（AMI）和中风，以及ACM、AMI、中风和急性冠状动脉综合征（ACS）及失代偿性心力衰竭（DHF）再住院）方面进行比较。
结果
在中位随访796天期间，在693例稳定的低风险门诊患者中，共观察到16例死亡、32例ACM、AMI和中风的复合终点以及83例ACM、AMI、中风、ACS再住院和DHF的复合终点。使用C统计量，仅测量hs-cTnT在预测整个研究人群的ACM方面优于ESC-SCORE（曲线下面积（AUC）差值0.221，p = 0.0039）以及两个预防组（非二级预防：AUC差值0.164，p = 0.0208；二级预防：AUC差值0.264，p = 0.0134）。对于所有其他次要终点的预测，hs-cTnT在二级预防和非二级预防中至少与ESC-SCORE一样有效。使用连续和分类净重新分类改善以及综合鉴别改善方法，hs-cTnT在整个人群和二级预防队列中显著改善了所有终点的重新分类。在非二级预防中，hs-cTnT仅改善了ACM的重新分类。这些结果在一个2046例患者的独立外部队列中得到了证实。
结论
对于有和没有相关心血管疾病的稳定门诊患者，hs-cTnT在预测ACM和复合终点方面优于多变量ESC-SCORE。
试验注册号
NCT01954303；预结果。
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