Prognostic Impact of Myocardial Injury Related to Various Cardiac and Noncardiac Conditions
Prognostic Impact of Myocardial Injury Related to Various Cardiac and Noncardiac Conditions
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DOI：
10.1016/j.amjmed.2015.12.009
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发表时间：
2016-05-01
影响因子：
5.9
通讯作者：
Mickley, Hans
中科院分区：
文献类型：
--
作者：
Sarkisian, Laura;Saaby, Lotte;Mickley, Hans
背景：心肌肌钙蛋白在心肌梗死以外的临床疾病中升高是众所周知的。对于此类事件，已提出术语“心肌损伤”。与各种心脏和非心脏临床疾病相关的心肌损伤患者的长期结局尚不清楚：2010年1月至2011年1月期间，我们前瞻性研究了根据临床指征测量心肌肌钙蛋白I的住院患者。心肌肌钙蛋白I值>30 ng/L且无心肌缺血证据的患者诊断为心肌损伤。将患者分为5类可能相关的疾病：心脏缺血性、心脏非缺血性、非心脏性、多因素或不确定。随访时间至少为3年，以全因死亡率作为单一终点。结果：共纳入3762例患者，其中1089例（29%）有心肌损伤。最常见的相关疾病为非心源性（n = 346）或多因素（n = 359）。心脏缺血性（n = 183）和心脏非缺血性（n = 134）疾病的发生频率较低。在平均3.2年后，645名患者（59%）死亡。多变量考克斯回归分析显示，心脏缺血性和心脏非缺血性疾病患者的死亡率无差异（风险比[HR] 0.75; 95%置信区间[CI]，0.50-1.13; P = 0.2）。然而，非心脏或多因素疾病患者的死亡率明显高于相关心脏缺血性疾病患者（HR 1.39; 95% CI，1.06-1.80; P = 0.02，HR 1.94; 95% CI，1.50-2.51; P <0.001）。在心肌损伤患者中，最常见的相关疾病是非心源性或多因素。值得注意的是，这些患者的长期死亡率明显高于那些有相关心脏疾病的患者。(C)2016 Elsevier Inc. All rights reserved.
BACKGROUND: Elevated cardiac troponins in clinical conditions other than myocardial infarction are well known. For such occurrences, the term "myocardial injury" has been proposed. The long-term outcome in patients with myocardial injury related to various cardiac and noncardiac clinical disorders is unknown.METHODS: During January 2010 to January 2011, we prospectively studied hospitalized patients who had cardiac troponin I measured on clinical indication. Patients with cardiac troponin I values >30 ng/L and no evidence of myocardial ischemia were diagnosed as having myocardial injury. Patients were classified into 5 categories of plausible related conditions: cardiac ischemic, cardiac nonischemic, noncardiac, multifactorial, or indeterminate. Follow-up was a minimum of 3 years, with all-cause mortality as the single end-point.RESULTS: A total of 3762 patients were considered, of whom 1089 (29%) had myocardial injury. The most common associated conditions were noncardiac (n = 346) or multifactorial (n = 359). Cardiac ischemic (n = 183) and cardiac nonischemic (n = 134) conditions occurred less frequently. After a median of 3.2 years, 645 patients (59%) had died. A multivariate Cox regression analysis showed no difference in mortality between patients with cardiac ischemic and cardiac nonischemic conditions (hazard ratio [HR] 0.75; 95% confidence interval [CI], 0.50-1.13; P = .2). Patients with noncardiac or multifactorial disorders, however, had significantly higher mortality than those with associated cardiac ischemic conditions (HR 1.39; 95% CI, 1.06-1.80; P = .02, and HR 1.94; 95% CI, 1.50-2.51; P < .001), respectively.CONCLUSIONS: In patients with myocardial injury, the most common associated conditions were noncardiac or multifactorial. Of notice, these patients had significantly higher long-term mortality when compared with those with associated cardiac conditions. (C) 2016 Elsevier Inc. All rights reserved.