Medical Science Research Center, Institute of Clinical Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, China.
Chin Med J (Engl). 2024 Aug 20;137(16):1965-1972. doi: 10.1097/CM9.0000000000003206. Epub 2024 Jul 12.
The potential impact of pre-existing coronary artery stenosis (CAS) on acute pulmonary embolism (PE) episodes remains underexplored. This study aimed to investigate the association between pre-existing CAS and the elevation of high-sensitivity cardiac troponin I (hs-cTnI) levels in patients with PE.
In this multicenter, prospective case-control study, 88 cases and 163 controls matched for age, sex, and study center were enrolled. Cases were patients with PE with elevated hs-cTnI. Controls were patients with PE with normal hs-cTnI. Coronary artery assessment utilized coronary computed tomographic angiography or invasive coronary angiography. CAS was defined as ≥50% stenosis of the lumen diameter in any coronary vessel >2.0 mm in diameter. Conditional logistic regression was used to evaluate the association between CAS and hs-cTnI elevation.
The percentage of CAS was higher in the case group compared to the control group (44.3% [39/88] vs. 30.1% [49/163]; P = 0.024). In multivariable conditional logistic regression model 1, CAS (adjusted odds ratio [OR], 2.680; 95% confidence interval [CI], 1.243-5.779), heart rate >75 beats/min (OR, 2.306; 95% CI, 1.056-5.036) and N-terminal pro-B type natriuretic peptide (NT-proBNP) >420 pg/mL (OR, 12.169; 95% CI, 4.792-30.900) were independently associated with elevated hs-cTnI. In model 2, right CAS (OR, 3.615; 95% CI, 1.467-8.909) and NT-proBNP >420 pg/mL (OR, 13.890; 95% CI, 5.288-36.484) were independently associated with elevated hs-cTnI.
CAS was independently associated with myocardial injury in patients with PE. Vigilance towards CAS is warranted in patients with PE with elevated cardiac troponin levels.
先前存在的冠状动脉狭窄（CAS）对急性肺栓塞（PE）发作的潜在影响仍未得到充分探讨。本研究旨在探讨 PE 患者中先前存在的 CAS 与高敏心肌肌钙蛋白 I（hs-cTnI）水平升高之间的关系。
本研究采用多中心前瞻性病例对照研究，共纳入 88 例病例和 163 例对照，两组按年龄、性别和研究中心匹配。病例组为 hs-cTnI 升高的 PE 患者，对照组为 hs-cTnI 正常的 PE 患者。采用冠状动脉计算机断层血管造影或有创冠状动脉造影评估冠状动脉。CAS 定义为任何直径>2.0mm 的冠状动脉≥50%管腔狭窄。采用条件逻辑回归评估 CAS 与 hs-cTnI 升高之间的关系。
病例组的 CAS 发生率高于对照组（44.3% [39/88] vs. 30.1% [49/163]；P=0.024）。在多变量条件逻辑回归模型 1 中，CAS（调整优势比 [OR]，2.680；95%置信区间 [CI]，1.243-5.779）、心率>75 次/分（OR，2.306；95% CI，1.056-5.036）和 N 末端 pro-B 型利钠肽（NT-proBNP）>420pg/ml（OR，12.169；95% CI，4.792-30.900）与 hs-cTnI 升高独立相关。在模型 2 中，右冠状动脉 CAS（OR，3.615；95% CI，1.467-8.909）和 NT-proBNP>420pg/ml（OR，13.890；95% CI，5.288-36.484）与 hs-cTnI 升高独立相关。
CAS 与 PE 患者的心肌损伤独立相关。在 hs-cTnI 升高的 PE 患者中，应警惕 CAS 的存在。
