Prognostic Value of Serum Tenascin-C Levels on Long-Term Outcome After Acute Myocardial Infarction
Prognostic Value of Serum Tenascin-C Levels on Long-Term Outcome After Acute Myocardial Infarction
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DOI：
10.1016/j.cardfail.2012.02.009
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发表时间：
2012-06-01
影响因子：
6
通讯作者：
Aonuma, Kazutaka
中科院分区：
文献类型：
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作者：
Sato, Akira;Hiroe, Michiaki;Aonuma, Kazutaka
背景：TN-C是一种细胞外基质糖蛋白，在成人心脏中不表达，但在各种病理条件下短暂表达，在组织重塑中发挥重要作用。目前尚不清楚血清TN-C水平是否增加了独立于传统预后标志物的预后信息。方法和结果：我们评估了239例成功接受经皮冠状动脉介入治疗的首次ST段抬高心肌梗死患者。于入院后第5天测定血清总胆固醇(Tn-C)和血浆B型利钠肽(BNP)水平，并比较长期临床结果。在随访期(24.3+/-13个月)中，54名患者经历了主要的复合心脏事件(心源性死亡或因心力衰竭加重而住院)。多变量COX比例风险分析显示，调整多个混杂因素后，血清TN-C(危险比2.92，95%可信区间1.55-5.67；P<；.001)和血浆BNP水平(危险比1.84，95%可信区间1.17-2.97；P=0.008)是心脏事件的显著独立预测因素。联合应用Tn-C和BNP可使c统计量从0.821增加到0.877(P&t；.001)，综合辨别能力提高14.0%(P&t；.001)。结论：入院后第5天血清Tn-C水平可用于急性心肌梗死后早期危险分层。(J心力衰竭2012；18：480-486)
Background: Tenascin-C (TN-C), an extracellular matrix glycoprotein, is not normally expressed in the adult heart but transiently reappears under various pathologic conditions to play important roles in tissue remodeling. It is unclear whether serum TN-C levels add prognostic information independent from traditional prognostic markers.Methods and Results: We assessed 239 patients with first ST-segment elevation myocardial infarction who underwent successful percutaneous coronary intervention. We measured serum TN-C and plasma B-type natriuretic peptide (BNP) levels on day 5 after admission and compared long-term clinical outcome. During the follow-up period (24.3 +/- 13 months), 54 patients experienced primary composite cardiac events (cardiac death or hospitalization for worsening heart failure). Multivariable Cox proportional hazards analysis indicated that serum TN-C (hazard ratio 2.92, 95% confidence interval [CI] 1.55-5.67; P < .001) and plasma BNP levels (hazard ratio 1.84, 95% CI 1.17-2.97; P = .008) were significant independent predictors for cardiac events after adjustment for multiple confounders. The combination of TN-C and BNP resulted in an increase of the c-statistic from 0.821 to 0.877 (P < .001) and an integrated discrimination improvement gain of 14.0% (P < .001).Conclusions: Serum TN-C level on day 5 after admission is potentially useful for early risk stratification after AMI beyond established prognostic markers. (J Cardiac Fail 2012;18:480-486)