Relation of Troponin I Levels Following Nonemergent Percutaneous Coronary Intervention to Short- and Long-Term Outcomes
Relation of Troponin I Levels Following Nonemergent Percutaneous Coronary Intervention to Short- and Long-Term Outcomes
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DOI：
10.1016/j.amjcard.2009.06.032
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发表时间：
2009-11-01
影响因子：
2.8
通讯作者：
Wong, S. Chiu
中科院分区：
文献类型：
--
作者：
Feldman, Dmitriy N.;Minutello, Robert M.;Wong, S. Chiu
非紧急经皮冠状动脉介入治疗 (PCI) 后肌酸激酶 (CK) 和 CK-MB 心肌酶的升高与随访期间心血管事件风险增加相关。然而，关于 PCI 术后心肌肌钙蛋白 I (cTnI) 单独升高而 CK-MB 不升高的发生率和预后意义的数据有限。本研究的目的是评估单独的 cTnI 升高对接受非急诊 PCI 且 PCI 后 CK-MB 水平正常的患者长期生存的影响。使用 2004/2005 康奈尔血管成形术登记处，我们评估了 1,601 例术前 cTnI 和 CK-MB 以及术后 CK-MB 水平正常的患者（接受选择性或紧急 PCI）的临床结果。根据 PCI 后 cTnI 升高的情况将患者分为 2 组。平均随访时间为 24.6 +/- 7.6 个月。 831 名患者 (51.9%) 观察到 cTnI 升高。 87% 的患者使用了药物洗脱支架，48% 的患者使用了糖蛋白 IIb/IIIa 抑制剂。 cTnI 升高和未升高的患者的院内主要不良心血管事件发生率较低，分别为 0.1% 和 0% (p = 1.000)。随访 2 年时，cTnI 升高的患者和未升高的患者的 Kaplan-Meier 生存率分别为 94.1% 和 96.4%（对数秩 p = 0.020）。通过多变量 Cox 回归分析，PCI 后 cTnI 增加（风险比 1.62，95% 置信区间 1.01 至 2.59，p = 0.047）是长期死亡率增加的独立预测因子。总之，非紧急 PCI 后 cTnI 单独升高是常见的，与 cTnI 正常的患者相比，与更频繁的不良院内结局无关，并且提供了有关死亡率的长期预后信息。 (C) 2009 Elsevier Inc. 保留所有权利。 （美国心脏杂志 2009 年；104：1210-1215）
Increases of creatine kinase (CK) and CK-MB cardiac enzymes after nonemergent percutaneous coronary intervention (PCI) have been associated with an increased risk of cardiovascular events during follow-up. However, there are limited data about the incidence and prognostic significance of an isolated increase of cardiac troponin I (cTnI) without an increase in CK-MB after PCI. The aim of this study was to evaluate the impact of an isolated cTnI increase on long-term survival in patients undergoing nonemergent PCI with normal CK-MB levels after PCI. Using the 2004/2005 Cornell Angioplasty Registry, we evaluated the clinical outcomes in 1,601 patients (undergoing elective or urgent PCI) with normal preprocedure cTnI and CK-MB and normal CK-MB levels after the procedure. Patients were divided into 2 groups based on the presence of cTnI increase after PCI. The mean follow-up period was 24.6 +/- 7.6 months. An increase in cTnI was observed in 831 patients (51.9%). Drug-eluting stents were used in 87% of patients and glycoprotein IIb/IIIa inhibitors were administered in 48% of patients. Incidence of in-hospital major adverse cardiovascular events was low, 0.1% versus 0% (p = 1.000), in patients with versus without cTnI increases, respectively. By 2 years of follow-up, Kaplan-Meier survival rates were 94.1% versus 96.4% (log-rank p = 0.020) in those with versus without cTnI increases, respectively. By multivariate Cox regression analysis, an increase in cTnI after PCI (hazard ratio 1.62, 95% confidence interval 1.01 to 2.59, p = 0.047) was an independent predictor of increased long-term mortality. In conclusion, an isolated increase in cTnI after nonemergent PCI is common, not associated with more frequent adverse in-hospital outcomes compared to patients with normal cTnI, and provides long-term prognostic information regarding mortality. (C) 2009 Elsevier Inc. All rights reserved. (Am J Cardiol 2009;104: 1210-1215)