Persistent cardiac troponin I elevation in stabilized patients after an episode of acute coronary syndrome predicts long-term mortality
Persistent cardiac troponin I elevation in stabilized patients after an episode of acute coronary syndrome predicts long-term mortality
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DOI：
10.1161/circulationaha.107.708529
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发表时间：
2007-10-23
期刊：
影响因子：
37.8
通讯作者：
Lindahl, Bertil
中科院分区：
文献类型：
--
作者：
Eggers, Kai M.;Lagerqvist, Bo;Lindahl, Bertil
背景-在非ST段抬高急性冠状动脉综合征患者中，任何肌钙蛋白升高都与心血管事件风险增加相关。然而，在这方面，在非ST段抬高急性冠脉综合征发作后病情稳定的患者中，持续性肌钙蛋白升高的患病率和预后重要性尚不清楚，因此在本研究中进行了评估。1092例稳定患者在入组FRAgmin和快速血运重建术后6周、3个月和6个月时在冠状动脉不稳定期间进行了测量。动脉疾病（FRISC-II）试验。使用Access AccuTnI检测试剂盒分析cTnI，并应用不同的预后临界值。通过5年评估结果。第6周时，48%的研究患者cTnI水平升高>0.01 μ g/L，第6个月时为36%，所有3次测量时为26%。cTnI升高与年龄增加和其他心血管高危特征相关。最低检测cTnI临界值（0.01 μ g/L）在诊断上最有用，并且是死亡率的独立预测因子（风险比，2.1 [ 95%置信区间，1.3至3.3]; P = 0.001），根据调整心血管危险因素的多变量分析，随机分为侵入性与非侵入性治疗策略，结论：在非ST段抬高型急性冠脉综合征发作后病情稳定的患者中，使用敏感的检测方法可以经常检测到持续的微小cTnI升高。cTnI水平升高>0.01 μ g/L可预测长期随访期间的死亡率。我们的研究结果强调了出院后非ST段抬高急性冠脉综合征患者进一步肌钙蛋白检测的重要性。
Background - In patients with non -ST-elevation acute coronary syndrome, any troponin elevation is associated with an increased risk for cardiovascular events. However, the prevalence and prognostic importance of persistent troponin elevation in stabilized patients after an episode of non -ST-elevation acute coronary syndrome are unknown and were therefore assessed in this study.Methods and Results - Cardiac troponin I ( cTnI) was measured in 1092 stabilized patients at 6 weeks and 3 and 6 months after enrollment in the FRagmin and Fast Revascularization during InStability in Coronary artery disease ( FRISC-II) trial. cTnI was analyzed with the Access AccuTnI assay with the application of different prognostic cutoffs. Outcomes were assessed through 5 years. Elevated cTnI levels >0.01 mu g/L were found in 48% of the study patients at 6 weeks, in 36% at 6 months, and in 26% at all 3 measurements. cTnI elevation was associated with increased age and other cardiovascular high-risk features. The lowest tested cTnI cutoff ( 0.01 mu g/L) was prognostically most useful and was independently predictive of mortality ( hazard ratio, 2.1 [ 95% confidence interval, 1.3 to 3.3]; P = 0.001) on multivariable analysis adjusted for cardiovascular risk factors and randomization to an invasive versus noninvasive treatment strategy, whereas it was related to myocardial infarction only on univariate analysis.Conclusions - Persistent minor cTnI elevation can be detected frequently in patients stabilized after an episode of non -ST-elevation acute coronary syndrome with the use of a sensitive assay. Elevated cTnI levels >0.01 mu g/L predict mortality during long-term follow-up. Our results emphasize the importance of further troponin testing in non -ST-elevation acute coronary syndrome patients after hospital discharge.