Prognostic role of tissue plasminogen activator in coronary artery disease with or without aortic valve sclerosis.
Prognostic role of tissue plasminogen activator in coronary artery disease with or without aortic valve sclerosis.
复制标题
作者：
我们试图研究循环组织纤溶酶原激活物（t-PA）水平与伴或不伴主动脉瓣硬化（AVSc）的稳定性冠状动脉疾病患者的长期结局之间的关系。测定了347名连续患有（n = 183）或不患有（n = 164）AVSC的稳定型心绞痛患者的血清t-PA水平。前瞻性记录结局，作为计划的临床评价，每6个月一次，最长7年。主要终点是心血管死亡和因心力衰竭再次住院的复合终点。次要终点包括全因死亡率、心血管死亡和因心力衰竭再次住院。AVSc患者的血清t-PA显著高于非AVSc患者（2131.22 pg/mL vs. 1495.85 pg/mL，P < 0.001）。对于AVSc患者，t-PA水平高于中位数（>1840.68 pg/mL）的患者更有可能达到主要和次要终点（均P < 0.001）。调整潜在混杂因素后，血清t-PA水平在考克斯比例风险模型中对每个终点仍具有显著预测性。t-PA的预后价值良好，AUC-ROC为0.753（P < 0.001）。t-PA与传统风险因素的结合改善了AVSC患者的风险重新分类，净重新分类指数为0.857，综合区分改善为0.217（均P < 0.001）。然而，对于无AVSC的患者，无论t-PA水平如何，主要终点和次要终点均相似。循环t-PA升高可增加稳定性冠状动脉疾病AVSC患者长期临床结局不良的风险。
We sought to investigate the relationship between circulating tissue plasminogen activator (t‐PA) level and long‐term outcomes in stable coronary artery disease patients with or without aortic valve sclerosis (AVSc). Serum levels of t‐PA were determined in 347 consecutive stable angina patients with (n = 183) or without (n = 164) AVSc. Outcomes were prospectively recorded as planned clinic evaluations every 6 months up to 7 years. The primary endpoint was a composite of cardiovascular death and rehospitalization due to heart failure. The secondary endpoint included all‐cause mortality, cardiovascular death, and rehospitalization due to heart failure. Serum t‐PA was significantly higher in AVSc than in non‐AVSc patients (2131.22 pg/mL vs. 1495.85 pg/mL, P < 0.001). For patients with AVSc, those with t‐PA level above the median (>1840.68 pg/mL) were more likely to meet the primary and secondary endpoints (all P < 0.001). After adjusting for potential confounding factors, serum t‐PA level remained significantly predictive for each endpoint in the Cox proportional hazard models. The prognostic value of t‐PA was good, with an AUC‐ROC of 0.753 (P < 0.001). The combination of t‐PA with traditional risk factors improved the risk reclassification of AVSc patients, with a net reclassification index of 0.857 and an integrated discrimination improvement of 0.217 (all P < 0.001). However, for patients without AVSc, both primary and secondary endpoints were similar, irrespective of t‐PA levels. Elevated circulating t‐PA confers an increased risk for poor long‐term clinical outcomes in stable coronary artery disease patients with AVSc.
登录
查看更多内容
DOI：
10.2967/jnumed.114.152355
发表时间：
2015-06
期刊：
Journal of nuclear medicine : official publication, Society of Nuclear Medicine
影响因子：
--
作者：
Jung JJ;Razavian M;Challa AA;Nie L;Golestani R;Zhang J;Ye Y;Russell KS;Robinson SP;Heistad DD;Sadeghi MM
通讯作者：
Sadeghi MM
影响因子：
37.8
作者：
ELLIS, SG;VANDORMAEL, MG;BULLE, TM
通讯作者：
BULLE, TM
影响因子：
5.4
作者：
Milin AC;Vorobiof G;Aksoy O;Ardehali R
通讯作者：
Ardehali R
影响因子：
24
作者：
Chandra, HR;Goldstein, JA;O'Neill, WW
通讯作者：
O'Neill, WW
影响因子：
4.4
作者：
Gong, Pian;Li, Mingchang;Xu, Zhou
通讯作者：
Xu, Zhou