Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
State Key Laboratory of Cardiovascular Disease, A 167, Beilishi Road, Xicheng District, Beijing 100037, China.
Eur Heart J Acute Cardiovasc Care. 2022 Aug 9;11(8):597-606. doi: 10.1093/ehjacc/zuac070.
To explore the association between elevated cardiac troponin I (cTnI) on 30-day mortality in patients with acute type A aortic dissection (ATAAD).
A total of 1321 consecutive patients who were admitted to the emergency department of Fuwai Hospital from January 2016 to December 2020 were enrolled. Patients had computed tomography-confirmed ATAAD and were measured serum cTnI on admission. Patients were divided into the troponin-positive (cTnI > 0.02 ng/mL) or the troponin-negative group (cTnI ≤ 0.02 ng/mL). Troponin was detected by PATHFAST instrument produced by Medins Co., Ltd., and the reference range of normal value is 0-0.02 ng/mL. A total of 522 out of 1321 patients (39.5%) in our study had elevated cTnI, who had higher 30-day mortality rate compared with the troponin-negative group (44.4% vs. 19.4% P < 0.0001). Multivariate logistic regression results showed that elevated cTnI was an independent risk indicator for 30-day mortality (odds ratio: 2.582; 95% confidence interval: 1.357-4.914; P = 0.0039). The addition of elevated cTnI level to a clinical-based risk prediction model resulted in significant incremental prognostic value (AUC difference: 0.0261).
Elevated cTnI is common in patients with ATAAD, and is associated with increased 30-day mortality risk.
探讨急性 A 型主动脉夹层（ATAAD）患者入院时心脏肌钙蛋白 I（cTnI）升高与 30 天死亡率的关系。
共纳入 2016 年 1 月至 2020 年 12 月期间因急性 ATAAD 入住阜外医院急诊的 1321 例连续患者。所有患者均经计算机断层扫描确诊为 ATAAD，并于入院时测量血清 cTnI。根据 cTnI 水平将患者分为肌钙蛋白阳性组（cTnI＞0.02ng/ml）和肌钙蛋白阴性组（cTnI≤0.02ng/ml）。cTnI 采用 Medins 公司生产的 PATHFAST 仪器检测，正常参考值范围为 0-0.02ng/ml。在本研究中，1321 例患者中有 522 例（39.5%）cTnI 升高，其 30 天死亡率高于肌钙蛋白阴性组（44.4%比 19.4%，P＜0.0001）。多变量逻辑回归结果表明，cTnI 升高是 30 天死亡率的独立危险因素（比值比：2.582；95%置信区间：1.357-4.914；P=0.0039）。将 cTnI 升高水平加入基于临床的风险预测模型可显著提高预后价值（AUC 差值：0.0261）。
cTnI 升高在 ATAAD 患者中较为常见，与 30 天死亡率增加相关。
