Department of Medicine; Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden.
Department of Medicine, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden; Department of Cardiology, Södersjukhuset, Stockholm, Sweden.
Am J Cardiol. 2022 Apr 15;169:32-41. doi: 10.1016/j.amjcard.2021.12.044. Epub 2022 Jan 19.
It is unknown whether outcomes in patients with unstable angina pectoris (UAP) and myocardial injury are different from outcomes in patients with non-ST-segment myocardial infarction (NSTEMI) with low peak concentrations of high-sensitivity cardiac troponin T (hs-cTnT). This study aimed to compare the prognosis in patients with UAP and evidence of myocardial injury, with prognosis in patients with NSTEMI and different peak hs-cTnT concentrations. All visits to 7 different emergency departments in Sweden from December 9, 2009 to December 31, 2016 were identified (n = 5,225,075). We included all hospitalized patients with hs-cTnT >14 ng/L and a diagnosis of UAP or NSTEMI, with ≥2 hours-cTnT measurements. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for all-cause mortality and cardiovascular events, in patients with NSTEMI categorized according to peak hs-cTnT concentrations, compared with patients with UAP. Altogether, 11,944 patients were included, of whom 1,253 (10%) received a diagnosis of UAP. During a median follow-up of 3.0 years (interquartile [IQR] 1.6 to 4.7), 3,297 patients died. There was no difference comparing patients with NSTEMI with peak hs-cTnT of 15 to 49 ng/L to patients with UAP, with regards to long-term cardiovascular mortality (HR 1.15; 95% CI, 0.85 to 1.56), but the risk of recurrent myocardial infarction was higher in patients with NSTEMI (HR, 1.61; 95% CI, 1.29 to 2.00), and the risk of heart failure hospitalization slightly lower (HR 0.80, 95% CI, 0.64 to 0.99). In conclusion, patients with UAP and myocardial injury have a similar risk of death after discharge, but a lower risk of recurrent myocardial infarction and a marginally higher risk of heart failure, compared with patients with NSTEMI with moderately elevated hs-cTnT levels.
目前尚不清楚不稳定型心绞痛（UAP）和心肌损伤患者的结局是否与高敏心肌肌钙蛋白 T（hs-cTnT）低值的非 ST 段抬高型心肌梗死（NSTEMI）患者的结局不同。本研究旨在比较 UAP 合并心肌损伤患者的预后与不同 hs-cTnT 峰值浓度的 NSTEMI 患者的预后。从 2009 年 12 月 9 日至 2016 年 12 月 31 日，对瑞典 7 家不同急诊室的所有就诊情况进行了识别（n=5225075）。我们纳入了所有 hs-cTnT>14ng/L 且诊断为 UAP 或 NSTEMI 的住院患者，且至少有 2 次 hs-cTnT 测量。根据 hs-cTnT 峰值浓度，计算了 NSTEMI 患者的全因死亡率和心血管事件的风险比（HR），并与 UAP 患者进行了比较。共纳入 11944 例患者，其中 1253 例（10%）被诊断为 UAP。在中位随访 3.0 年（四分位距 [IQR] 1.6 至 4.7）期间，3297 例患者死亡。与 UAP 相比，hs-cTnT 峰值在 15 至 49ng/L 的 NSTEMI 患者的长期心血管死亡率无差异（HR 1.15；95%CI，0.85 至 1.56），但 NSTEMI 患者的复发性心肌梗死风险更高（HR 1.61；95%CI，1.29 至 2.00），心力衰竭住院风险略低（HR 0.80，95%CI，0.64 至 0.99）。总之，与 hs-cTnT 水平中度升高的 NSTEMI 患者相比，UAP 合并心肌损伤患者出院后死亡风险相似，但复发性心肌梗死风险较低，心力衰竭风险略高。
