Prognostic Value of Cardiac Troponin-I or Troponin-T Elevation Following Nonemergent Percutaneous Coronary Intervention: A Meta-analysis
Prognostic Value of Cardiac Troponin-I or Troponin-T Elevation Following Nonemergent Percutaneous Coronary Intervention: A Meta-analysis
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DOI：
10.1002/ccd.22962
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发表时间：
2011-06-01
影响因子：
2.3
通讯作者：
Wong, S. Chiu
中科院分区：
文献类型：
--
作者：
Feldman, Dmitriy N.;Kim, Luke;Wong, S. Chiu
目的：本荟萃分析的目的是评估大量队列/登记研究中非紧急经皮冠状动脉介入治疗（PCI）后cTnT或cTnI升高的患病率和死亡率的预后价值。背景：择期PCI术后常规测量心肌肌钙蛋白在介入医师中一直存在争议。最近的研究提供了关于非紧急PCI后心肌肌钙蛋白T（cTnT）和肌钙蛋白I（cTnI）升高的预测价值的相互矛盾的数据。研究方法：对报告择期PCI后cTnT或cTnI升高的预后影响的所有已发表研究进行了电子和手动检索。以随访时的全因死亡率作为主要终点进行荟萃分析。结果：我们确定了1998年至2009年间发表的22项研究，涉及22，353例患者。术后cTnT和cTnI升高的患者分别为25.9%和34.3%。随访时间范围为3至67个月（平均：17.7 +/- 14.9个月）。结果显示试验间无异质性（Q检验：25.39; I-2：17%; P = 0.23）。未检测到发表偏倚（Egger检验：P = 0.16）。PCI术后cTnI或cTnT升高患者的长期全因死亡率（5.8%）显著高于cTnI或cTnT未升高患者（4.4%）; OR 1.45（95%CI：1.22-1.72），P < 0.01。此外，PCI术后cTnI或cTnT升高的患者（9.2%）的术后复合不良临床事件全因死亡或心肌梗死（MI）显著高于cTnI或cTnT未升高的患者（5.3%）; OR 1.77（95% CI：1.48-2.11），P < 0.01。结论：目前的荟萃分析表明，非紧急PCI后cTnI或cTnT升高表明长期全因死亡率以及全因死亡率和MI的复合不良事件增加。常规监测围手术期cTn水平沿着更密集的门诊监测/治疗cTn升高的患者可能有助于改善这些患者在非紧急PCI后的长期不良结局。(C)2011 Wiley-Liss，Inc.
Objectives: The aim of this meta-analysis was to assess the prevalence and prognostic value regarding mortality of cTnT or cTnI elevations after nonemergent percutaneous coronary intervention (PCI) in a large number of cohort/registry studies. Background: Routine cardiac troponin measurement after elective PCI has been controversial among interventionalists. Recent studies have provided conflicting data in regard to predictive value of cardiac troponin-T (cTnT) and troponin-I (cTnI) elevation after nonemergent PCI. Methods: Electronic and manual searches were conducted of all published studies reporting on the prognostic impact of cTnT or cTnI elevation after elective PCI. A meta-analysis was performed with all-cause mortality at follow-up as the primary endpoint. Results: We identified 22 studies, involving 22,353 patients, published between 1998 and 2009. Postprocedural cTnT and cTnI were elevated in 25.9% and 34.3% of patients, respectively. Follow-up period ranged from 3 to 67 months (mean: 17.7 +/- 14.9 months). The results showed no heterogeneity among the trials (Q-test: 25.39; I-2: 17%; P = 0.23). No publication bias was detected (Egger's test: P = 0.16). The long-term all-cause mortality in patients with cTnI or cTnT elevation after PCI (5.8%) was significantly higher when compared to patients without cTnI or cTnT elevation (4.4%); OR 1.45 (95% CI: 1.22-1.72), P < 0.01. In addition, the postprocedural composite adverse clinical events of all-cause mortality or myocardial infarction (MI) in patients with cTnI or cTnT elevation after PCI (9.2%) was significantly higher when compared to patients without cTnI or cTnT elevation (5.3%); OR 1.77 (95% CI: 1.48-2.11), P < 0.01. Conclusions: The current meta-analysis indicates that cTnI or cTnT elevation after nonemergent PCI is indicative of an increase in long-term all-cause mortality as well as the composite adverse events of all-cause mortality and MI. Efforts to routinely monitor periprocedural cTn levels along with more intensive outpatient monitoring/treatment of patients with cTn elevations may help to improve the long-term adverse outcomes in these patients following non-emergent PCI. (C) 2011 Wiley-Liss, Inc.