Independent Researcher, Atlanta, GA, USA.
Department of Health Sciences, Houston Community College (Coleman), Houston, TX, USA.
Curr Med Res Opin. 2024 Oct;40(10):1685-1695. doi: 10.1080/03007995.2024.2401632. Epub 2024 Sep 18.
High-sensitivity cardiac troponins (Hs-cTns) are reliable indicators of myocardial injury, but their relationship with cardiovascular outcomes remains less understood. This study explores the association between adverse cardiac events and Hs-cTnT levels exceeding 14 ng/L in patients with stable CAD.
Thirteen pertinent studies were identified using specific keywords from a pool of 208 articles retrieved from PubMed, Scopus, and Google Scholar, spanning 2013 to 2023. The primary outcomes included all-cause mortality (ACM), myocardial infarction (MI), cardiovascular death (CVD), rehospitalization due to decompensated heart failure (RDHF), need for revascularization, and stroke. Comprehensive meta-analysis (CMA) was employed to analyze the data for odds ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using I statistics, and both qualitative assessment (Newcastle-Ottawa Scale) and quantitative analysis (Egger's and Beggs test, funnel plots) were conducted.
The analysis included 29,115 participants (74.72% male) with a mean age of 68.34 years. It revealed a significantly elevated risk of ACM among stable CAD patients with Hs-cTnT levels >14 ng/L compared to those with levels <14 ng/L (11.2% vs. 3.3%; OR = 5.46; 95% CI = 1.53-19.54; = 0.009). Similarly, higher risks were observed for MI (10.9% vs 3.6%; OR = 3.12; 95% CI = 0.98-9.95, = 0.053), CVD (8.1% vs. 2.1%; OR = 3.37; 95% CI = 1.74-6.50; < 0.0001), and RDHF (6.62% vs. 0.92%; OR = 9.46; 95% CI = 4.65-19.24; < 0.0001). Notably, major adverse cardiovascular events (MACE) exhibited a stronger association with Hs-cTnT levels (18.2% vs 7.81%; OR = 1.89; 95% CI = 0.80-4.43; I = 97%; = 0.14) compared to Hs-cTnI levels (20.1% vs 21.1%; OR = 1.30; 95% CI = 1.03-1.64; I <0.0001%; = 0.03).
Elevated levels of Hs-cTnT (>14 ng/L) are significantly associated with increased risks of RDHF and ACM in patients with stable CAD. Further large-scale prospective studies are warranted to refine risk assessment strategies and mitigate cardiovascular mortality in this population.
高敏心肌肌钙蛋白（Hs-cTn）是心肌损伤的可靠指标，但它与心血管结局的关系仍知之甚少。本研究探讨了在稳定性 CAD 患者中，Hs-cTnT 水平超过 14ng/L 与不良心脏事件之间的关系。
通过从 PubMed、Scopus 和 Google Scholar 中检索到的 208 篇文章中使用特定关键词，确定了 13 项相关研究。主要结局包括全因死亡率（ACM）、心肌梗死（MI）、心血管死亡（CVD）、因心力衰竭失代偿而再住院（RDHF）、需要血运重建以及卒中。采用综合荟萃分析（CMA）分析比值比（OR）和 95%置信区间（CI）的数据。使用 I 统计量评估异质性，并进行定性评估（纽卡斯尔-渥太华量表）和定量分析（Egger 检验和 Begg 检验、漏斗图）。
分析纳入了 29115 名参与者（74.72%为男性），平均年龄为 68.34 岁。结果表明，与 Hs-cTnT 水平<14ng/L 的患者相比，Hs-cTnT 水平>14ng/L 的稳定性 CAD 患者发生 ACM 的风险显著增加（11.2%比 3.3%；OR=5.46；95%CI=1.53-19.54；=0.009）。同样，MI（10.9%比 3.6%；OR=3.12；95%CI=0.98-9.95；=0.053）、CVD（8.1%比 2.1%；OR=3.37；95%CI=1.74-6.50；<0.0001）和 RDHF（6.62%比 0.92%；OR=9.46；95%CI=4.65-19.24；<0.0001）的风险也更高。值得注意的是，主要不良心血管事件（MACE）与 Hs-cTnT 水平的相关性更强（18.2%比 7.81%；OR=1.89；95%CI=0.80-4.43；I=97%；=0.14），而与 Hs-cTnI 水平的相关性则稍弱（20.1%比 21.1%；OR=1.30；95%CI=1.03-1.64；I<0.0001%；=0.03）。
Hs-cTnT 水平升高（>14ng/L）与稳定性 CAD 患者 RDHF 和 ACM 风险增加显著相关。需要进一步进行大规模前瞻性研究，以完善风险评估策略并降低该人群的心血管死亡率。
