Frequency and clinical implications of discordant creatine kinase-MB and troponin measurements in acute coronary syndromes
Frequency and clinical implications of discordant creatine kinase-MB and troponin measurements in acute coronary syndromes
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DOI：
10.1016/j.jacc.2005.08.062
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发表时间：
2006-01-17
影响因子：
24
通讯作者：
Peterson, ED
中科院分区：
文献类型：
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作者：
Newby, LK;Roe, MT;Peterson, ED
我们试图评估非ST段抬高急性冠状动脉综合征（NSTE ACS）患者不一致的心脏标志物结果与住院死亡率和治疗模式之间的相关性。背景肌酸激酶-MB（CK-MB）和心肌肌钙蛋白（cTn）通常在NSTE ACS患者中同时测量。CK-MB和cTn结果不一致的意义尚不清楚。方法在CRUSADE倡议的29，357例ACS患者中，我们检查了四种标志物组合的关系，（CK-MB-/cTn-、CK-MB+/cTn-、CK-MB-/cTn+、CK-MB+/cTn+）与死亡率及美国心脏病学会/美国心脏协会指南推荐的急性护理的关系CK-MB+/cTn-10%，CK-MB-/cTn+18%。CK-MB-/cTn-患者的住院死亡率为2.7%; CK-MB+/cTn-患者为3.0%; CK-MB-/cTn+患者为4.5%; CK-MB +/cTn+患者为5.9%。校正其他风险因素后，CK-MB+/cTn-患者的死亡率比值比（OR）为1.02（95%置信区间[CI] 0.75 - 1.38），CK-MB-/cTn+患者的OR为1.15（95% CI 0.86 - 1.54），CK-MB+/cTn+患者的OR为1.53（95% CI 1.18 - 1.98）。尽管可变的风险，CK-MB+/肌钙蛋白-和CK-MB-/肌钙蛋白+的患者进行了类似的治疗与早期抗血栓药物和导管为基础的interventions.CONCLUSIONS NSTE ACS患者中，肌钙蛋白水平升高确定患者急性风险增加，无论CK-MB状态，但孤立的CK-MB+状态具有有限的预后价值。认识到这些风险差异可能有助于所有cTn+患者更适当地早期使用抗血栓治疗和侵入性管理。
OBJECTIVES We sought to evaluate the association between discordant cardiac marker results and in-hospital mortality and treatment patterns in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS).BACKGROUND Creatine kinase-MB (CK-MB) and cardiac troponins (cTn) are often measured concurrently in patients with NSTE ACS. The significance of discordant CK-MB and cTn results is unknown.METHODS Among 29,357 ACS patients in the CRUSADE initiative who had both CK-MB and cTn measured during the first 36 hours, we examined relationships of four marker combinations (CK-MB-/cTn-, CK-MB+/cTn-, CK-MB-/cTn+, and CK-MB+/cTn+) with mortality and American College of Cardiology/American Heart Association guidelines-recommended acute care.RESULTS The CK-MB and cTn results were discordant in 28% of patients (CK-MB+/cTn-, 10%; CK-MB-/cTn+, 18%). In-hospital mortality was 2.7% among CK-MB-/cTn- patients; 3.0%, CK-MB+/cTn-; 4.5%, CK-MB-/cTn+; and 5.9%, CK-MB+/cTn+. After adjustment for other presenting risk factors, patients with CK-MB+/cTn- had a mortality odds ratio (OR) of 1.02 (95% confidence interval [CI] 0.75 to 1.38), those with CK-MB-/cTn+ had an OR of 1.15 (95% CI 0.86 to 1.54), and those with CK-MB+/cTn+ had an OR of 1.53 (95% CI 1.18 to 1.98). Despite variable risk, patients with CK-MB+/cTn- and CK-MB-/cTn+ were treated similarly with early antithrombotic agents and catheter-based interventions.CONCLUSIONS Among patients with NSTE ACS, an elevated troponin level identifies patients at increased acute risk regardless of CK-MB status, but an isolated CK-MB+ status has limited prognostic value. Recognition of these risk differences may contribute to more appropriate early use of antithrombotic therapy and invasive management for all cTn+ patients.