Prediction of recurrent events by D-dimer and inflammatory markers in patients with normal cardiac troponin I (PREDICT) study
Prediction of recurrent events by D-dimer and inflammatory markers in patients with normal cardiac troponin I (PREDICT) study
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DOI：
10.1016/s0002-8703(03)00169-8
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发表时间：
2003-06-01
影响因子：
4.8
通讯作者：
Adgey, AAJ
中科院分区：
文献类型：
--
作者：
Menown, IBA;Mathew, TP;Adgey, AAJ
背景D-二聚体和炎症标志物对急性胸痛但心肌肌钙蛋白I（cTnI）水平正常的患者复发不良事件风险的独立预测价值尚不清楚。在初始和12小时样本中测量肌酸激酶-心肌带同工酶（CK-MB）质量和cTnI水平。在初始样本中测定可溶性细胞间粘附分子（sICAM）-1、血管细胞粘附分子（sVCAM）-1、sP-选择素、sE-选择素、高敏C反应蛋白（hsCRP）、白细胞介素-6（IL-6）、纤维蛋白原和d-二聚体水平。确定1年内死亡、心肌梗死（MI）、血运重建或胸痛再入院的发生率以死亡/心肌梗死为主要终点。（195/391 [50%]）的风险低于CK-MBmass或cTnI水平升高的患者，但仍有重要事件发生率（77/195[39%]）。标记物升高定义为>第75百分位数（上四分位数）。D-二聚体水平升高（>580 ng/mL）可预测死亡/MI（比值比，5.4; 95% CI，1.5-20.2; P = .005）。sP-选择素水平升高（>152 ng/mL;比值比，3.2; 95% CI，0.9-11.6; P = 0.06）倾向于增加死亡/MI率，hsCRP水平升高（>7.1 mg/L）、11.6（>10.7 pg/mL）和ST段压低的趋势较弱。其他标志物、其他心电图变化或经典风险因素不能预测死亡/MI。与多变量分析，D-二聚体和sP-选择素被发现，是独立的意义，死亡/MI后调整炎症，止血，心电图标记物和D-二聚体调整后的经典riskfactors.Conclusion正常cTnI水平急性胸痛后不赋予未来的风险。同时评估d-二聚体和炎症标志物可改善危险分层。
Background The independent predictive value of d-dimer and inflammatory markers for the risk of recurrent adverse events in patients with acute chest pain but normal levels of cardiac troponin I (cTnI) remains unclear.Methods We studied 391 patients admitted to the hospital in 1 year with acute ischemic-type chest pain. Creatine kinase-myocardial band isoenzyme (CK-MB) mass and cTnI levels were measured in initial and 12-hour samples. Soluble intercellular adhesion molecule (sICAM)-1, vascular cell adhesion molecule (sVCAM)-1, sP-selectin, sE-selectin, high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), fibrinogen, and d-dimer levels were measured in initial samples. A 1-year incidence of death, myocardial infarction (MI), revascularization, or readmission with chest pain was determined (with death/MI as the primary end point).Results Patients with normal levels of CK-MBmass and cTnI (195/391 [50%]) were at a lower risk than patients with elevated levels of CK-MBmass or cTnI, but still had an important incidence of events (77/195[39%]). Marker elevation was defined as >75th percentile (upper quartile). Elevated d-dimer levels (>580 ng/mL) was predictive of death/MI (odds ratio, 5.4; 95% CI, 1.5-20.2; P = .005). Elevated sP-selectin levels (>152 ng/mL; odds ratio, 3.2; 95% CI, 0.9-11.6; P = .06) trended to increased death/MI rates, with weaker trends for elevated levels of hsCRP (>7.1 mg/L), 11.6 (>10.7 pg/mL), and ST depression. Other markers, other electrocardiogram changes, or classic risk factors were, not predictive of death/MI. With a multivariate analysis, d-dimer and sP-selectin were found,to be of independent significance for death/MI after adjustment for inflammatory, hemostatic, and electrocardiogram markers and d-dimer after adjustment for classic risk factors.Conclusion Normal cTnI levels after acute chest pain does not confer absence of future risk. Concurrent assessment of d-dimer and inflammatory markers may improve risk stratification.