JAMA Cardiol :高敏肌钙蛋白有助于评估心血管病风险

2020-08-07 朱朱 中国循环杂志

研究者发现,将高敏肌钙蛋白水平加入到指南提出的心血管风险评估方法中后,可明显改善对心血管病患者的风险分层,具体表现在于,可将11.9%的患者重新分入到更合适的组别,从而接受更合适的降脂治疗。

对于动脉粥样硬化性血管病(以下简称心血管病)患者,2018年美国胆固醇管理指南根据心血管事件及高危因素,将其分为极高危和非极高危两个组,并采用不同的降脂治疗策略。然而,8月5日JAMA心脏病学子刊在线发表的一项研究表明,该指南对心血管病患者的心血管风险评估方法存在缺陷,应将高敏肌钙蛋白水平纳入其中。

研究者发现,将高敏肌钙蛋白水平加入到指南提出的心血管风险评估方法中后,可明显改善对心血管病患者的风险分层,具体表现在于,可将11.9%的患者重新分入到更合适的组别,从而接受更合适的降脂治疗。

研究者认为,在评估心血管病患者未来的心血管风险时,应考虑高敏肌钙蛋白水平,这样可优化心血管患者的二级预防治疗。

该研究显示,在2018年美国胆固醇管理指南评估的非极高危心血管病患者中,高敏肌钙蛋白I水平超过6 ng/L(风险阈值)的患者中3年心血管事件的发生率(9.1%)与极高危患者(8.8%)一样。

而在指南界定的极高危患者中,高敏肌钙蛋白I水平低于检测下限(<2 ng/L)的患者中心血管事件的发生率(2.7%)与非极高危患者(5%)相似。

根据临床标准评估的极高危心血管病患者中3年心血管事件发生风险是非极高危患者的2倍。

加入高敏肌钙蛋白水平后,11.9%的心血管病患者重新归类,其中,9.1%(1/11)的极高危患者和25%的非极高危患者被重新分类。

在极高危心血管病患者中,高敏肌钙蛋白I水平低于检测下限者占9%。在非极高危患者中,高敏肌钙蛋白I水平>6 ng/L者占22.6%。

该研究纳入PEGASUS-TIMI 54研究中8635例患者,所有患者在纳入前1~3年发生心肌梗死,至少50岁,至少有1个高危因素。患者的平均年龄为65岁,76.6%为男士。

原始出处:

Nicholas A Marston, Marc P Bonaca, Petr Jarolim, et al.Clinical Application of High-Sensitivity Troponin Testing in the Atherosclerotic Cardiovascular Disease Framework of the Current Cholesterol Guidelines.JAMA Cardiol. 2020 Aug 5. doi: 10.1001/jamacardio.2020.2981.

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    2020-10-14 lovetcm

    #高敏肌钙蛋白#,可能会被纳入一些心血管评分量表中,可能会更为精确预测#心血管病风险#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=892003, encodeId=988e89200388, content=<a href='/topic/show?id=1b72102420dd' target=_blank style='color:#2F92EE;'>#高敏肌钙蛋白#</a>,可能会被纳入一些心血管评分量表中,可能会更为精确预测<a href='/topic/show?id=69ae518e618' target=_blank style='color:#2F92EE;'>#心血管病风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102420, encryptionId=1b72102420dd, topicName=高敏肌钙蛋白), TopicDto(id=51876, encryptionId=69ae518e618, topicName=心血管病风险)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Wed Oct 14 14:09:08 CST 2020, time=2020-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1782092, encodeId=eefe1e820927a, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Sun Mar 28 00:51:23 CST 2021, time=2021-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1644856, encodeId=f24716448565d, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=64bb23195917, createdName=Luyuxie_17, createdTime=Sun Mar 28 03:51:23 CST 2021, time=2021-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036209, encodeId=f8b5103620906, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Fri Aug 07 18:51:23 CST 2020, time=2020-08-07, status=1, ipAttribution=)]
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  4. [GetPortalCommentsPageByObjectIdResponse(id=892003, encodeId=988e89200388, content=<a href='/topic/show?id=1b72102420dd' target=_blank style='color:#2F92EE;'>#高敏肌钙蛋白#</a>,可能会被纳入一些心血管评分量表中,可能会更为精确预测<a href='/topic/show?id=69ae518e618' target=_blank style='color:#2F92EE;'>#心血管病风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102420, encryptionId=1b72102420dd, topicName=高敏肌钙蛋白), TopicDto(id=51876, encryptionId=69ae518e618, topicName=心血管病风险)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Wed Oct 14 14:09:08 CST 2020, time=2020-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1782092, encodeId=eefe1e820927a, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Sun Mar 28 00:51:23 CST 2021, time=2021-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1644856, encodeId=f24716448565d, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=64bb23195917, createdName=Luyuxie_17, createdTime=Sun Mar 28 03:51:23 CST 2021, time=2021-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036209, encodeId=f8b5103620906, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Fri Aug 07 18:51:23 CST 2020, time=2020-08-07, status=1, ipAttribution=)]
    2020-08-07 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

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