在伴有急性心肌梗死的院外心脏骤停患者中进行目标温度管理时两种不同高敏肌钙蛋白的动力学：一项随机临床试验的事后亚研究。
Kinetics of 2 different high-sensitive troponins during targeted temperature management in out-of-hospital cardiac arrest patients with acute myocardial infarction: a post hoc sub-study of a randomised clinical trial.
机构信息
Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
Department of Clinical Sciences, University of Bergen, Bergen, Norway.
出版信息
BMC Cardiovasc Disord. 2022 Jul 30;22(1):342. doi: 10.1186/s12872-022-02778-4.
INTRODUCTION
Short term hypothermia has been suggested to have cardio protective properties in acute myocardial infarction (AMI) by reducing infarct size as assessed by troponins. There are limited data on the kinetics of these biomarkers in comatose out-of-hospital cardiac arrest (OHCA) patients, with and without AMI, undergoing targeted temperature management (TTM) in the ICU.
PURPOSE
The aim of this post hoc analyses was to evaluate and compare the kinetics of two high-sensitivity cardiac troponins in OHCA survivors, with and without acute myocardial infarction (AMI), during TTM of different durations [24 h (standard) vs. 48 h (prolonged)].
METHODS
In a sub-cohort (n = 114) of the international, multicentre, randomized controlled study "TTH48" we measured high-sensitive troponin T (hs-cTnT), high-sensitive troponin I (hs-cTnI) and CK-MB at the following time points: Arrival, 24 h, 48 h and 72 h from reaching the target temperature range of 33 ± 1 °C. All patients diagnosed with an AMI at the immediate coronary angiogram (CAG)-18 in the 24-h group and 25 in the 48-h group-underwent PCI with stent implantation. There were no stent thromboses.
RESULTS
Both the hs-cTnT and hs-cTnI changes over time were highly influenced by the cause of OHCA (AMI vs. non-AMI). In contrast to non-AMI patients, both troponins remained elevated at 72 h in AMI patients. There was no difference between the two time-differentiated TTM groups in the kinetics for the two troponins.
CONCLUSION
In comatose OHCA survivors with an aetiology of AMI levels of both hs-cTnI and hs-cTnT remained elevated for 72 h, which is in contrast to the well-described kinetic profile of troponins in normotherm AMI patients. There was no difference in kinetic profile between the two high sensitive assays. Different duration of TTM did not influence the kinetics of the troponins.
TRIAL REGISTRATION
Clinicaltrials.gov Identifier: NCT01689077, 20/09/2012.
简介
短期低温被认为具有心脏保护作用，可以通过肌钙蛋白评估缩小急性心肌梗死（AMI）的梗死面积。在 ICU 中接受目标温度管理（TTM）的昏迷院外心脏骤停（OHCA）患者中，有或没有 AMI 的情况下，关于这些生物标志物的动力学数据有限。
目的
本事后分析旨在评估和比较 TTM 不同持续时间（24 小时[标准]与 48 小时[延长]）下，OHCA 幸存者中存在和不存在急性心肌梗死（AMI）的两种高敏心肌肌钙蛋白的动力学。
方法
在国际多中心随机对照研究“TTH48”的一个亚组（n=114）中，我们在以下时间点测量高敏肌钙蛋白 T（hs-cTnT）、高敏肌钙蛋白 I（hs-cTnI）和 CK-MB：到达、24 小时、48 小时和 72 小时达到目标温度范围 33±1°C。在 24 小时组的即时冠状动脉造影（CAG）-18 中诊断为 AMI 的所有患者和 48 小时组的 25 名患者进行了经皮冠状动脉介入治疗（PCI）并植入支架。没有支架血栓形成。
结果
hs-cTnT 和 hs-cTnI 的变化随时间的推移均受到 OHCA 原因（AMI 与非 AMI）的高度影响。与非 AMI 患者相比，AMI 患者的两种肌钙蛋白在 72 小时仍升高。在两种时间区分的 TTM 组中，两种肌钙蛋白的动力学没有差异。
结论
在病因学为 AMI 的昏迷 OHCA 幸存者中，两种 hs-cTnI 和 hs-cTnT 的水平升高持续 72 小时，这与体温正常的 AMI 患者中肌钙蛋白的描述良好的动力学特征相反。两种高敏检测方法的动力学特征没有差异。TTM 的持续时间不同不会影响肌钙蛋白的动力学。
试验注册
Clinicaltrials.gov 标识符：NCT01689077，2012 年 9 月 20 日。
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