高敏肌钙蛋白对普通人群预后的预测作用：一项系统评价和荟萃分析。

High-sensitivity troponins for outcome prediction in the general population: a systematic review and meta-analysis.

作者信息

Aimo Alberto, Georgiopoulos Georgios, Panichella Giorgia, Vergaro Giuseppe, Passino Claudio, Emdin Michele, Clerico Aldo

机构信息

Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.

Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece; School of Biomedical Engineering and Imaging Sciences, King's College London, UK.

出版信息

Eur J Intern Med. 2022 Apr;98:61-68. doi: 10.1016/j.ejim.2022.01.012. Epub 2022 Jan 7.

DOI:10.1016/j.ejim.2022.01.012

PMID:35012816

Abstract

BACKGROUND

High-sensitivity (hs) assays allow to measure cardiac troponin T and I (cTnT/I) even in healthy individuals. The higher hs-cTn values, the higher the ongoing cardiomyocyte damage, and then reasonably the risk of developing symptomatic cardiac disease.

METHODS

We retrieved all studies evaluating the prognostic value of hs-cTnT or I in the general population. We calculated pooled hazard ratio (HR) values for all-cause and cardiovascular death, cardiovascular events and heart failure (HF) hospitalization.

RESULTS

We included 24 studies for a total of 203,202 subjects; 11 studies assessed hs-cTnT and 14 hs-cTnI. One standard deviation (SD) increase in baseline hs-cTn was associated with a 23% higher risk of all-cause death (HR 1.226, 95% CI 1.083-1.388, p<0.001, I=88.5%); all these studies measured hs-cTnI. In an exploratory analysis on 3 studies with 25,760 subjects, hs-cTn predicted cardiovascular death (HR 1.822, 95% CI 1.241-2.674, p=0.002, I=87.2%). After synthesizing 9 studies with 58,565 subjects, hs-cTn predicted cardiovascular events (HR 1.328, 95% CI 1.167-1.513, p<0.001, I=93.8%). Both hs-cTnT (HR 1.627, 95% CI 1.145-2.311, p<0.001) and hs-cTnI (HR 1.260, 95% CI 1.115-1.423, p<0.001; p for interaction <0.001). Furthermore, in 10 studies with 61,467 subjects, hs-cTn predicted HF hospitalization (HR 1.493, 95% CI 1.368-1.630, p<0.001, I=76.6%). Both hs-cTnT (HR 1.566, 95% CI 1.303-1.883, p<0.001) and hs-cTnI (HR 1.467, 95% CI 1.321-1.628, p<0.001) were associated with HF hospitalization (p for interaction <0.001).

CONCLUSIONS

hs-cTn values hold strong prognostic value in subjects from the general population, predicting the risk of all-cause and cardiovascular mortality, cardiovascular events, and HF hospitalization.

摘要

背景

高敏（hs）检测方法能够检测出即使是健康个体中的心肌肌钙蛋白T和I（cTnT/I）。hs-cTn值越高，心肌细胞正在进行的损伤就越严重，进而患症状性心脏病的风险也相应越高。

方法

我们检索了所有评估hs-cTnT或I在普通人群中预后价值的研究。我们计算了全因死亡、心血管死亡、心血管事件和心力衰竭（HF）住院的合并风险比（HR）值。

结果

我们纳入了24项研究，共203,202名受试者；11项研究评估了hs-cTnT，14项研究评估了hs-cTnI。基线hs-cTn每增加一个标准差（SD），全因死亡风险就会增加23%（HR 1.226，95% CI 1.083 - 1.388，p<0.001，I=88.5%）；所有这些研究均检测了hs-cTnI。在对3项共25,760名受试者的研究进行的探索性分析中，hs-cTn可预测心血管死亡（HR 1.822，95% CI 1.241 - 2.674，p=0.002，I=87.2%）。综合9项共58,565名受试者的研究后，hs-cTn可预测心血管事件（HR 1.328，95% CI 1.167 - 1.513，p<0.001，I=93.8%）。hs-cTnT（HR 1.627，95% CI 1.145 - 2.311，p<0.001）和hs-cTnI（HR 1.260，95% CI 1.115 - 1.423，p<0.001；交互作用p<0.001）均有此关联。此外，在10项共61,467名受试者的研究中，hs-cTn可预测HF住院（HR 1.493，95% CI 1.368 - 1.630，p<0.001，I=76.6%）。hs-cTnT（HR 1.566，95% CI 1.303 - 1.883，p<0.001）和hs-cTnI（HR 1.467，95% CI 1.321 - 1.628，p<0.001）均与HF住院有关（交互作用p<0.001）。