Do High-sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?
Do High-sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?
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DOI：
10.1111/acem.13709
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发表时间：
2019-05-01
影响因子：
4.4
通讯作者：
Sun, Benjamin C.
中科院分区：
文献类型：
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作者：
Clark, Carol L.;Gibson, Thomas A.;Sun, Benjamin C.
目的在美国，每年因晕厥/近晕厥就诊的急诊科（艾德）估计有120万例。在艾德评价过程中经常获得心脏生物标志物，但指标高敏肌钙蛋白（hscTnT）和利钠肽（NT-proBNP）的预后价值尚不清楚。本研究的目的是确定在艾德采集的hscTnT和NT-proBNP是否与晕厥成人患者的30天死亡/严重心脏结局独立相关。方法2013年4月至2016年9月期间，在11家美国医院对一项前瞻性、观察性试验进行了预先指定的二次分析，该试验招募了年龄>= 60岁、出现晕厥的参与者。排除包括癫痫发作、卒中、短暂性脑缺血发作、创伤、中毒、低血糖、持续性意识模糊、机械/电气发明、既往入组或预期随访不良。在签署知情同意书后3小时内，采集hscTnT和NT-proBNP，随后分别使用Roche Elecsys Gen 5 STAT和2010 Cobas进行集中分析。主要结局为30天全因死亡率和严重心脏事件。调整疾病严重程度，使用多变量逻辑回归分析，估计主要结局和生物标志物之间的变化，使用贝叶斯马尔可夫链蒙特卡罗方法调整与生物标志物范围相关的绝对风险。结果该队列包括3，392例患者; 367例（10.8%）经历了主要结局。主要结局的校正绝对风险随hscTnT和NT-proBNP水平升高而升高。HscTnT水平50 ng/L，风险为29%（95% CI = 26%-33%）。NT-proBNP水平> 2，000 ng/L，风险为29%（95% CI = 25%-32%）。似然比和预测值显示了相似的结果。排除艾德指数严重结局的敏感性分析显示了相似的结果。结论hscTnT和NT-proBNP是老年艾德晕厥患者30天死亡和严重预后的独立预测因子。
Objectives An estimated 1.2 million annual emergency department (ED) visits for syncope/near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high-sensitivity troponin (hscTnT) and natriuretic peptide (NT-proBNP) are unclear. The objective of this study was to determine if hscTnT and NT-proBNP drawn in the ED are independently associated with 30-day death/serious cardiac outcomes in adult patients presenting with syncope. Methods A prespecified secondary analysis of a prospective, observational trial enrolling participants >= age 60 presenting with syncope, at 11 United States hospitals, was conducted between April 2013 and September 2016. Exclusions included seizure, stroke, transient ischemic attack, trauma, intoxication, hypoglycemia, persistent confusion, mechanical/electrical invention, prior enrollment, or predicted poor follow-up. Within 3 hours of consent, hscTnT and NT-proBNP were collected and later analyzed centrally using Roche Elecsys Gen 5 STAT and 2010 Cobas, respectively. Primary outcome was combined 30-day all-cause mortality and serious cardiac events. Adjusting for illness severity, using multivariate logistic regression analysis, variations between primary outcome and biomarkers were estimated, adjusting absolute risk associated with ranges of biomarkers using Bayesian Markov Chain Monte Carlo methods. Results The cohort included 3,392 patients; 367 (10.8%) experienced the primary outcome. Adjusted absolute risk for the primary outcome increased with hscTnT and NT-proBNP levels. HscTnT levels 50 ng/L, a 29% (95% CI = 26%-33%) risk. NT-proBNP levels 2,000 ng/L a 29% (95% CI = 25%-32%) risk. Likelihood ratios and predictive values demonstrated similar results. Sensitivity analyses excluding ED index serious outcomes demonstrated similar findings. Conclusions hscTnT and NT-proBNP are independent predictors of 30-day death and serious outcomes in older ED patients presenting with syncope.