Utility of Cardiac Biomarkers in Predicting Infarct Size, Left Ventricular Function, and Clinical Outcome After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction
Utility of Cardiac Biomarkers in Predicting Infarct Size, Left Ventricular Function, and Clinical Outcome After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction
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DOI：
10.1016/j.jcin.2008.04.010
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发表时间：
2008-08-01
影响因子：
11.3
通讯作者：
Jang, Ik-Kyung
中科院分区：
文献类型：
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作者：
Chia, Stanley;Senatore, Fred;Jang, Ik-Kyung
我们试图确定最佳心脏生物标志物，以预测st段抬高型心肌梗死（STEMI）患者接受经皮冠状动脉介入治疗（PCI）的梗死面积、左心室射血分数（LVEF）和临床结果。心肌生物标志物，肌酸激酶（CK）， CK- mb，肌钙蛋白T和肌钙蛋白I是心肌梗死后的常规检测。然而，它们与STEMI患者PCI术后功能和临床结果的相关性尚不明确。方法在EVOLVE（评估MCC-135对急性心肌梗死左心室抢救的作用）试验中，患者随机接受细胞内钙调节剂作为首次大STEMI的辅助PCI治疗。378名患者在PCI前和连续72小时内测定心脏生物标志物水平。在5天和30天后进行单光子发射计算机断层扫描，并监测患者长达180天。结果PCI术后CK、CK- mb及肌钙蛋白T、I的单时间点、峰值及时间-浓度曲线下面积均与梗死面积及LVEF显著相关。特别是，72小时肌钙蛋白I （TnI72h）与5天和30天梗死面积密切相关（r < 0.70; p < 0.001）。TnI72h阈值>55 ng/ml对大梗死面积（>= 10%）和低LVEF (
Objectives We sought to determine the best cardiac biomarker to predict infarct size, left ventricular ejection fraction (LVEF), and clinical outcome in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).Background The cardiac biomarkers, creatine kinase (CK), CK-MB, and troponins T and I are routinely measured after myocardial infarction. However, their correlation with functional and clinical outcomes after PCI for STEMI is not well established.Methods In the EVOLVE (EValuation Of MCC-135 for Left VEntricular Salvage in Acute Myocardial Infarction) trial, patients were randomized to receive intracellular calcium modulator as adjunct to primary PCI for first large STEMI. Cardiac biomarker levels were determined in 378 patients before PCI and serially up to 72 h. Single-photon emission computed tomography was performed after 5 and 30 days, and patients were monitored up to 180 days.Results All single time-point, peak, and area under time-concentration curve of CK, CK-MB, and troponins T and I after PCI significantly correlated with infarct size and LVEF. In particular, 72-h troponin I (TnI72h) correlated strongly with 5-day and 30-day infarct size (r > 0.70; p < 0.001). A TnI72h threshold >55 ng/ml was 90% sensitive for large infarct size (>= 10%) and low LVEF (