Functional Area of Emergency Medicine, Karolinska University Hospital, 14184, Stockholm.
Heart and Vascular Theme, Functional Area of Ischemic Heart Disease, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Heart. 2019 Dec;105(24):1905-1912. doi: 10.1136/heartjnl-2019-315036. Epub 2019 Jul 23.
There is a paucity of data regarding prognosis in patients with acute versus chronic myocardial injury for long-term outcomes. We hypothesised that patients with chronic myocardial injury have a similar long-term prognosis as patients with acute myocardial injury.
In an observational cohort study of 22 589 patients who had high-sensitivity cardiac troponin T (hs-cTnT) measured in the emergency department during 2011-2014, we identified all patients with level >14 ng/L and categorised them as acute myocardial injury, type 1 myocardial infarction (T1MI), type 2 myocardial infarction (T2MI) or chronic myocardial injury through adjudication. We estimated adjusted HRs with 95% CIs for the primary outcome all-cause mortality and secondary outcomes MI, and heart failure in patients with acute myocardial injury, T1MI and T2MI compared with chronic myocardial injury.
In total, 3853 patients were included. During 3.9 (±2) years of follow-up, 48%, 24%, 44% and 49% of patients with acute myocardial injury, T1MI, T2MI and chronic myocardial injury died, respectively. Patients with acute myocardial injury had higher adjusted risks of death (1.21, 95% CI 1.08 to 1.36) and heart failure (1.24, 95% CI 1.07 to 1.43), but a similar risk for myocardial infarction (MI) compared with the reference group. Patients with T1MI had a lower adjusted risk of death (0.86, 95% CI 0.74 to 1.00) and higher risk of MI (2.09, 95% CI 1.62 to 2.68), but a similar risk of heart failure. Patients with T2MI had a higher adjusted risk of death (1.46, 95% CI 1.18 to 1.80) and heart failure (1.30, 95% CI 1.00 to 1.69) compared with patients with chronic myocardial injury.
Absolute long-term risks for death are similar, and adjusted risks are slightly higher, among patients with acute myocardial injury and T2MI, respectively, compared with chronic myocardial injury. The lowest risk of long-term mortality was found in patients with T1MI. Both acute and chronic myocardial injury are associated with very high risks of adverse outcomes.
关于急性与慢性心肌损伤患者的长期预后，相关数据较为匮乏。我们假设慢性心肌损伤患者的长期预后与急性心肌损伤患者相似。
我们对 2011 年至 2014 年期间在急诊科接受高敏心肌肌钙蛋白 T（hs-cTnT）检测的 22589 例患者进行了一项观察性队列研究，根据 14ng/L 以上的 hs-cTnT 值将所有患者分为急性心肌损伤、1 型心肌梗死（T1MI）、2 型心肌梗死（T2MI）或慢性心肌损伤。通过裁决将所有急性心肌损伤、T1MI 和 T2MI 患者分类为急性心肌损伤、1 型心肌梗死（T1MI）、2 型心肌梗死（T2MI）或慢性心肌损伤。我们估计了急性心肌损伤、T1MI 和 T2MI 患者与慢性心肌损伤患者相比的全因死亡率和次要结局心肌梗死（MI）、心力衰竭的主要结局所有原因死亡率的调整后 HR（95%CI）。
共纳入 3853 例患者。在 3.9（±2）年的随访期间，急性心肌损伤、T1MI、T2MI 和慢性心肌损伤患者的死亡率分别为 48%、24%、44%和 49%。与对照组相比，急性心肌损伤患者的死亡（1.21，95%CI 1.08 至 1.36）和心力衰竭（1.24，95%CI 1.07 至 1.43）的调整后风险更高，但 MI 风险相似。T1MI 患者的死亡风险（0.86，95%CI 0.74 至 1.00）较低，MI（2.09，95%CI 1.62 至 2.68）风险较高，但心力衰竭风险相似。与慢性心肌损伤患者相比，T2MI 患者的死亡（1.46，95%CI 1.18 至 1.80）和心力衰竭（1.30，95%CI 1.00 至 1.69）的调整后风险更高。
与慢性心肌损伤相比，急性心肌损伤和 T2MI 患者的绝对长期死亡风险相似，调整后的风险略高。T1MI 患者的长期死亡率最低。急性和慢性心肌损伤均与极高的不良结局风险相关。
