JACC:未确诊患者心肌肌钙蛋白升高不可小觑

2019-01-15 国际循环编辑部 国际循环

心肌肌钙蛋白(cTn)升高是急诊入院患者的常见表现,即使在无急性冠状动脉综合征(ACS)的情况下也如此。在这些患者中,一部分人未发现cTn升高的病因,而肌钙蛋白血症有时用于描述这种情况。JACC发表的这项研究旨在探讨cTn水平与ACS患者的临床表现和长期预后的关系,这些患者在未明确诊断的情况下出院。

心肌肌钙蛋白(cTn)升高是急诊入院患者的常见表现,即使在无急性冠状动脉综合征(ACS)的情况下也如此。在这些患者中,一部分人未发现cTn升高的病因,而肌钙蛋白血症有时用于描述这种情况。JACC发表的这项研究旨在探讨cTn水平与ACS患者的临床表现和长期预后的关系,这些患者在未明确诊断的情况下出院。



该回顾性队列研究纳入48 872例患者(SWEDEHEART注册研究),将患者分为cTn水平≤特异性测定第99百分位数组,并且在更高水平的情况下通过特异性测定cTn三分位数分离。

结果显示,受试者中9800例(20.1%)患者cTn水平>第99百分位数。cTn水平较高的患者,血管危险因素以及血管和非心血管合并症的患病率增加。共有7529例(15.4%)患者出现主要不良事件(MAE),定义为全因死亡,心肌梗死,心力衰竭再入院或卒中(中位随访4.9年)的复合。MAE风险与较高的cTn分层相关(最高特异性测定cTn三分位数HR=2.59;95%CI:2.39~2.80;无心血管合并症、肾功能不全、左心室功能不全或显著冠状动脉狭窄患者HR=3.57;95%CI:2.30~5.54)。

结论,cTn升高与心血管和非心血管合并症相关,并可预测急诊入院尚无明确诊断患者的主要不良事件。因此,临床实践中,不要认为肌钙蛋白血症微不足道,相反,应对患者仔细检查。

原始出处:
Kai M. Eggers, Tomas Jernberg and Bertil Lindahl, et al. Cardiac Troponin Elevation in Patients Without a Specific Diagnosis. JACC. January 2019.

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    2019-05-22 hbwxf
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    2019-01-18 flysky120

    心肌肌钙蛋白也要注意高低

    0

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