择期经皮冠状动脉介入治疗（PCI）患者术后心肌肌钙蛋白I升高及其与5年死亡率的关联
Post-procedural elevated cardiac troponin I and the association with 5-year mortality in patients undergoing elective PCI.
作者信息
Sun Queyun, Zhu Pei, Xu Jingjing, Jiang Lin, Chen Yan, Zhao Xueyan, Song Lei, Yang Yuejin, Gao Runlin, Xu Bo, Yuan Jinqing, Song Ying
机构信息
Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, A 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
出版信息
Heliyon. 2024 Mar 22;10(7):e27979. doi: 10.1016/j.heliyon.2024.e27979. eCollection 2024 Apr 15.
BACKGROUND
The clinically meaningful cardiac troponin I (cTnI) threshold associated with the long-term prognosis in patients undergoing elective percutaneous coronary intervention (PCI) is still debated.
OBJECTIVE
To assess the association between different thresholds for post-procedural cTnI and 5-year mortality.
METHODS
The study included 4059 consecutive patients with normal baseline cTnI values who underwent elective PCI. The post-procedural cTnI level was measured at 8-48 h after PCI. The main study endpoints were 5-year all-cause mortality and cardiovascular mortality.
RESULTS
A cTnI ≥5 times the upper reference limit (URL) as defined by the fourth universal definition of myocardial infarction (4th UDMI), ≥35 times as defined by the Academic Research Consortium-2 criteria, and ≥70 times as defined by the Society for Cardiovascular Angiography and Interventions (SCAI [2014]) was identified in 33%, 6.6%, and 3.3% of patients, respectively. During 5 years of follow-up, the all-cause mortality rate was 3.4% (n = 132) and the cardiovascular mortality rate was 2.0% (n = 77). Both all-cause mortality and cardiovascular mortality increased with higher peak cTnI, and were independently predicted by a cTnI ≥70 times the URL (adjusted hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.20-5.02 and adjusted HR 3.17, 95% CI 1.31-7.67, respectively; reference, cTnI <1 × URL]. The SCAI (2014) threshold was significantly associated with 5-year cardiovascular mortality (adjusted HR 2.66, 95% CI 1.20-5.89; reference, cTnI, <70 × URL) and all-cause mortality (adjusted HR 2.23, 95% CI 1.16-4.30; reference, cTnI <70 × URL).
CONCLUSION
In patients with normal pre-procedural cTnI who underwent elective PCI, a post-procedural cTnI ≥70 times the URL independently predicted 5-year all-cause and cardiovascular mortality. Therefore, only the SCAI (2014) post-procedural cTnI threshold was independently associated with long-term mortality.
背景
对于接受择期经皮冠状动脉介入治疗（PCI）的患者，与长期预后相关的具有临床意义的心肌肌钙蛋白I（cTnI）阈值仍存在争议。
目的
评估PCI术后不同cTnI阈值与5年死亡率之间的关联。
方法
该研究纳入了4059例基线cTnI值正常且接受择期PCI的连续患者。PCI术后8 - 48小时测量术后cTnI水平。主要研究终点为5年全因死亡率和心血管死亡率。
结果
根据心肌梗死第四版通用定义（第4版UDMI）定义的cTnI≥正常上限（URL）的5倍、根据学术研究联盟 - 2标准定义的≥35倍以及根据心血管造影和介入学会（SCAI [2014]）定义的≥70倍的患者分别占33%、6.6%和3.3%。在5年的随访期间，全因死亡率为3.4%（n = 132），心血管死亡率为2.0%（n = 77）。全因死亡率和心血管死亡率均随cTnI峰值升高而增加，且cTnI≥URL的70倍可独立预测这两种死亡率（调整后风险比[HR]分别为2.45，95%置信区间[CI] 1.20 - 5.02和调整后HR 3.17，95% CI 1.31 - 7.67；参照组，cTnI <1×URL）。SCAI（2014）阈值与5年心血管死亡率（调整后HR 2.66，95% CI 1.20 - 5.89；参照组，cTnI <70×URL）和全因死亡率（调整后HR 2.23，95% CI 1.16 - 4.30；参照组，cTnI <70×URL）显著相关。
结论
在术前cTnI正常且接受择期PCI的患者中，术后cTnI≥URL的70倍可独立预测5年全因死亡率和心血管死亡率。因此，只有SCAI（2014）术后cTnI阈值与长期死亡率独立相关。
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