Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction
Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction
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DOI：
10.1056/nejmoa013456
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发表时间：
2002-06-27
影响因子：
158.5
通讯作者：
Berger, P
中科院分区：
文献类型：
--
作者：
Aviles, RJ;Askari, AT;Berger, P
背景：在疑似急性冠状动脉综合征的患者中，心肌肌钙蛋白 T 水平具有预后价值。然而，人们担心肾功能不全可能会损害预后价值，因为心肌肌钙蛋白 T 可能会被肾脏清除。 方法：我们分析了参与“全球使用开放闭塞冠状动脉策略 IV”试验的 7033 名患者的结果，这些患者拥有肌钙蛋白 T 水平和肌酐清除率的完整基线数据。如果肌钙蛋白 T 水平为 0.1 ng/mL 或更高，则视为异常，并以四分位数评估肌酐清除率。主要终点是30天内死亡或心肌梗塞的复合终点。结果：581名患者发生死亡或心肌梗塞。在肌酐清除率高于每分钟 58.4 毫升第 25 个百分位值的患者中，肌钙蛋白 T 水平异常升高预示着心肌梗塞或死亡风险增加（7% 与 5%；调整优势比，1.7；95% 置信区间，1.3 至 2.2；P
Background: Among patients with suspected acute coronary syndromes, cardiac troponin T levels have prognostic value. However, there is concern that renal dysfunction may impair the prognostic value, because cardiac troponin T may be cleared by the kidney.Methods: We analyzed the outcomes in 7033 patients enrolled in the Global Use of Strategies to Open Occluded Coronary Arteries IV trial who had complete base-line data on troponin T levels and creatinine clearance rates. The troponin T level was considered abnormal if it was 0.1 ng per milliliter or higher, and creatinine clearance was assessed in quartiles. The primary end point was a composite of death or myocardial infarction within 30 days.Results: Death or myocardial infarction occurred in 581 patients. Among patients with a creatinine clearance above the 25th percentile value of 58.4 ml per minute, an abnormally elevated troponin T level was predictive of an increased risk of myocardial infarction or death (7 percent vs. 5 percent; adjusted odds ratio, 1.7; 95 percent confidence interval, 1.3 to 2.2; P