J Interv Cardiol :心梗肌钙蛋白变化幅度有价值!

2020-08-14 朱朱 中国循环杂志

一项研究表明,对于ST段抬高型心肌梗死患者来说,急诊冠脉介入治疗后的心肌肌钙蛋白I(cTnI)水平峰值与入院时cTnI水平差值(△cTnI)越大,未来发生主要不良心血管事件的风险越高。

阜外医院颜红兵教授等发表的一项研究表明,对于ST段抬高型心肌梗死患者来说,急诊冠脉介入治疗后的心肌肌钙蛋白I(cTnI)水平峰值与入院时cTnI水平差值(△cTnI)越大,未来发生主要不良血管事件(死亡、再次心肌梗死发作、中风)的风险越高。

另外,△cTnI与入院时cTn水平的比值也对2年主要不良心血管事件发生风险有很强的预测能力。

校正多个因素的ROC曲线分析显示,与急诊冠脉介入治疗后的cTnI水平峰值与入院时的cTnI水平(AUC分别为0.59和0.546)相比,△cTnI和△cTnI与入院时cTn水平的比值(AUC分别为0.73和0.717)对2年主要不良心血管事件发生风险的预测价值更高。

多因素Cox回归分析表明,△cTnI是2年随访期间主要不良心血管事件的相关因素(HR=1.018)。

按四分位数区分,△cTnI最大(4.845~19.073 ng/ml)的患者中,前壁心肌梗死比例较高,患者的GRACE评分较高,肌酸激酶同工酶和肌红蛋白水平也较高。

K–M生存曲线分析显示,△cTnI最高四分位组患者发生主要不良心血管事件、死亡、心绞痛的风险明显高于其他三组患者。

研究者指出,该研究结果支持对接受急诊冠脉介入治疗的ST段抬高型心肌梗死患者反复检测cTnI水平,这样能提供更多的风险分层和长期预后信息。

该研究一共纳入2596例ST段抬高型心肌梗死患者,这些患者在入院时和急诊冠脉介入治疗后接受cTnI水平检测,其中1138例患者能获得△cTnI值。患者的平均年龄为59岁,3/4为男士。

中位随访2年期间,8.2%的患者发生主要不良心血管时间,其中6%的患者死亡,1.9%的患者中风。

原始出处:

Xiaoxiao Zhao, Ying Wang, Chen Liu, et al. Association between Variation of Troponin and Prognosis of Acute Myocardial Infarction before and after Primary Percutaneous Coronary Intervention. J Interv Cardiol, 2020 Jul 25.doi: 10.1155/2020/4793178. eCollection 2020.

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    2020-08-16 ms1000000223698072

    思路清晰

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    2020-08-15 1581f8c42cm

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    2020-08-15 1581f8c42cm

    0

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西班牙学者发表在JACC上的一项研究提示,在急性冠脉综合征患者中,营养不良很常见,而营养不良显著增加死亡和主要不良心血管事件发生风险。