A sensitive cardiac troponin T assay in stable coronary artery disease.
A sensitive cardiac troponin T assay in stable coronary artery disease.
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DOI：
10.1056/nejmoa0805299
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发表时间：
2009-12-24
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通讯作者：
Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial Investigators
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作者：
Omland T;de Lemos JA;Sabatine MS;Christophi CA;Rice MM;Jablonski KA;Tjora S;Domanski MJ;Gersh BJ;Rouleau JL;Pfeffer MA;Braunwald E;Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial Investigators
在大多数稳定型冠状动脉疾病患者中，血浆心肌肌钙蛋白T水平低于常规测定的检测限。极低循环肌钙蛋白T水平的分布和决定因素，以及它们与心血管事件的关系，在这些患者中是未知的。我们使用一种新的、高灵敏度的检测方法来测定3679例左心室功能正常的稳定型冠心病患者血浆样本中心肌肌钙蛋白T的浓度。在5.2年的中位随访期内，分析了与心血管事件发生率相关的试验结果。使用高灵敏度检测试剂盒，3593例患者（97.7%）的心肌肌钙蛋白T浓度等于或高于检测限（0.001 μg/L），407例患者（11.1%）的心肌肌钙蛋白T浓度等于或高于表观健康受试者的第99百分位数（0.0133 μg/L）。在调整其他独立预后指标后，心血管死亡的累积发生率有一个强烈的和分级的增加（肌钙蛋白T水平自然对数每单位增加的校正风险比，2.09; 95%置信区间[CI]，1.60 - 2.74; P<0.001）和心力衰竭（校正的风险比，2.20; 95% CI，1.66至2.90; P<0.001）。与较高水平的肌钙蛋白T相关的风险增加明显远低于传统心肌肌钙蛋白T检测的检测限，低于健康人群中数值的第99百分位数。用高灵敏度测定法测定的肌钙蛋白T水平与心肌梗死发生率之间无相关性（校正风险比，1.16; 95%CI，0.97 - 1.40; P = 0.11）。在校正其他独立预后指标后，用高灵敏度测定法测量的心肌肌钙蛋白T浓度与稳定性冠状动脉疾病患者的心血管死亡和心力衰竭的发生率显著相关，但与心肌梗死无关。
In most patients with stable coronary artery disease, plasma cardiac troponin T levels are below the limit of detection for the conventional assay. The distribution and determinants of very low circulating troponin T levels, as well as their association with cardiovascular events, in such patients are unknown. We used a new, high-sensitivity assay to determine the concentration of cardiac troponin T in plasma samples from 3679 patients with stable coronary artery disease and preserved left ventricular function. Results of the assay were analyzed in relation to the incidence of cardiovascular events during a median follow-up period of 5.2 years. With the highly sensitive assay, concentrations of cardiac troponin T were at or above the limit of detection (0.001 μg per liter) in 3593 patients (97.7%) and at or above the 99th percentile for apparently healthy subjects (0.0133 μg per liter) in 407 patients (11.1%). After adjustment for other independent prognostic indicators, there was a strong and graded increase in the cumulative incidence of cardiovascular death (adjusted hazard ratio per unit increase in the natural logarithm of the troponin T level, 2.09; 95% confidence interval [CI], 1.60 to 2.74; P<0.001) and of heart failure (adjusted hazard ratio, 2.20; 95% CI, 1.66 to 2.90; P<0.001) in this study group. Increased risk associated with higher levels of troponin T was evident well below the limit of detection of conventional cardiac troponin T assays and below the 99th percentile of values in a healthy population. There was no association between troponin T levels as measured with the highly sensitive assay and the incidence of myocardial infarction (adjusted hazard ratio, 1.16; 95% CI, 0.97 to 1.40; P = 0.11). After adjustment for other independent prognostic indicators, cardiac troponin T concentrations as measured with a highly sensitive assay were significantly associated with the incidence of cardiovascular death and heart failure but not with myocardial infarction in patients with stable coronary artery disease.