Cardiac troponin I elevation in hospitalized patients without acute coronary syndromes
Cardiac troponin I elevation in hospitalized patients without acute coronary syndromes
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DOI：
10.1016/j.amjcard.2008.01.011
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发表时间：
2008-05-15
影响因子：
2.8
通讯作者：
Markiewicz, Walter
中科院分区：
文献类型：
--
作者：
Blich, Miry;Sebbag, Anat;Markiewicz, Walter
心肌肌钙蛋白的增加发生在各种临床情况下，在没有急性冠状动脉综合征（ACS）。关于非ACS相关肌钙蛋白升高患者的发生率、临床特征、各种心脏诊断检查的预测价值和结局的数据很少。我们研究了883例连续住院的心肌肌钙蛋白I水平升高的患者。出院诊断重新分类，肌钙蛋白升高归因于ACS或其他过程。收集临床数据和心脏诊断试验结果。患者的中位随访时间为30个月。311例患者被归类为非ACS相关肌钙蛋白升高（35.2%）。在99%的患者中发现了肌钙蛋白升高的另一种解释。肌钙蛋白水平在区分ACS和非ACS患者方面的准确性较差（受试者工作特征曲线下面积0.63）。冠状动脉造影通常无助于排除非ACS相关肌钙蛋白升高，因为非ACS组中77%的患者患有显著的血流限制性冠状动脉疾病。与ACS患者相比，非ACS相关肌钙蛋白升高患者的院内（风险比2.8，95%置信区间2.0 - 3.8）和长期（风险比2.0，95%置信区间1.6 - 2.5）死亡率显著更高。总之，在没有ACS的住院患者中，心肌肌钙蛋白水平经常升高，预示着短期和长期预后不良。这些患者中的大多数对心肌肌钙蛋白升高有其他解释。心脏诊断程序通常无助于排除非ACS相关肌钙蛋白升高。(C)2008年爱思唯尔公司All rights reserved.
Increase of cardiac troponins occurs in a variety of clinical situations in the absence of an acute coronary syndrome (ACS). Few data exist regarding the incidence, clinical characteristics, and predictive value of various cardiac diagnostic tests and outcome of patients with a non-ACS-related troponin increase. We studied 883 consecutive hospitalized patients with increased cardiac troponin I levels. The discharge diagnosis was reclassified and troponin increase attributed to ACS or another process. Clinical data and results of cardiac diagnostic tests were collected. Patients were followed for a median of 30 months. Three hundred eleven patients were classified as having a non-ACS-related troponin increase (35.2%). An alternative explanation for troponin increase was found in 99% of these patients. Troponin level had poor accuracy in discriminating patients with and without ACS (area under the receiver operating characteristics curve 0.63). Coronary angiography was frequently unhelpful in excluding a non-ACS-related troponin increase because 77% of patients in the non-ACS group had significant flow-limiting coronary artery disease. Patients with non-ACS-related troponin increase had significantly higher in-hospital (hazard ratio 2.8, 95% confidence interval 2.0 to 3.8) and long-term (hazard ratio 2.0, 95% confidence interval 1.6 to 2.5) mortalities compared with patients with ACS. In conclusion, cardiac troponin level is frequently increased in hospitalized patients in the absence of an ACS and portends poor short- and long-term outcomes. Most of these patients have an alternative explanation for cardiac troponin increase. Cardiac diagnostic procedures are frequently unhelpful in excluding a non-ACS-related troponin increase. (C) 2008 Elsevier Inc. All rights reserved.