连续检测高敏心肌肌钙蛋白 T、氨基末端脑钠肽前体、高敏 C 反应蛋白和生长分化因子 15 对急性冠状动脉综合征后风险评估的影响：BIOMArCS 队列研究。
Serially measured high-sensitivity cardiac troponin T, N-terminal-pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, and growth differentiation factor 15 for risk assessment after acute coronary syndrome: the BIOMArCS cohort.
机构信息
Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
Department of Cardiology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, the Netherlands.
出版信息
Eur Heart J Acute Cardiovasc Care. 2023 Jul 7;12(7):451-461. doi: 10.1093/ehjacc/zuad042.
AIMS
Evidence regarding the role of serial measurements of biomarkers for risk assessment in post-acute coronary syndrome (ACS) patients is limited. The aim was to explore the prognostic value of four, serially measured biomarkers in a large, real-world cohort of post-ACS patients.
METHODS AND RESULTS
BIOMArCS is a prospective, multi-centre, observational study in 844 post-ACS patients in whom 12 218 blood samples (median 17 per patient) were obtained during 1-year follow-up. The longitudinal patterns of high-sensitivity cardiac troponin T (hs-cTnT), N-terminal-pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and growth differentiation factor 15 (GDF-15) were analysed in relation to the primary endpoint (PE) of cardiovascular mortality and recurrent ACS using multivariable joint models. Median age was 63 years, 78% were men and the PE was reached by 45 patients. The average biomarker levels were systematically higher in PE compared with PE-free patients. After adjustment for 6-month post-discharge Global Registry of Acute Coronary Events score, 1 standard deviation increase in log[hs-cTnT] was associated with a 61% increased risk of the PE [hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.02-2.44, P = 0.045], while for log[GDF-15] this was 81% (HR 1.81, 95% CI 1.28-2.70, P = 0.001). These associations remained significant after multivariable adjustment, while NT-proBNP and hs-CRP were not. Furthermore, GDF-15 level showed an increasing trend prior to the PE (Structured Graphical Abstract).
CONCLUSION
Longitudinally measured hs-cTnT and GDF-15 concentrations provide prognostic value in the risk assessment of clinically stabilized patients post-ACS.
CLINICAL TRIAL REGISTRATION
The Netherlands Trial Register. Currently available at URL https://trialsearch.who.int/; Unique Identifiers: NTR1698 and NTR1106.
目的
关于生物标志物连续测量在急性冠脉综合征（ACS）后患者风险评估中的作用的证据有限。本研究旨在探讨在一个大型真实世界的 ACS 后患者队列中，四种连续测量的生物标志物的预后价值。
方法和结果
BIOMArCS 是一项前瞻性、多中心、观察性研究，纳入了 844 名 ACS 后患者，在 1 年随访期间共采集了 12218 份血样（每名患者中位数为 17 份）。使用多变量联合模型分析高敏心肌肌钙蛋白 T（hs-cTnT）、N 末端 B 型利钠肽前体（NT-proBNP）、高敏 C 反应蛋白（hs-CRP）和生长分化因子 15（GDF-15）的纵向变化与主要终点（PE）心血管死亡率和复发性 ACS 的关系。中位年龄为 63 岁，78%为男性，45 名患者达到 PE。与无 PE 患者相比，PE 患者的平均生物标志物水平普遍更高。在校正 6 个月后出院全球急性冠脉事件评分后，log[hs-cTnT]每增加 1 个标准差，PE 的风险增加 61%[危险比（HR）1.61，95%置信区间（CI）1.02-2.44，P=0.045]，而 log[GDF-15]则增加 81%（HR 1.81，95%CI 1.28-2.70，P=0.001）。这些关联在多变量调整后仍然显著，而 NT-proBNP 和 hs-CRP 则不然。此外，GDF-15 水平在 PE 发生前呈上升趋势（结构化图表摘要）。
结论
在 ACS 后临床稳定患者的风险评估中，连续测量的 hs-cTnT 和 GDF-15 浓度提供了预后价值。
临床试验注册
荷兰临床试验注册处。目前可在 URL https://trialsearch.who.int/ 上获得；唯一标识符：NTR1698 和 NTR1106。
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