Ann Neurol:轻度卒中或TIA后心肌肌钙蛋白与复发性主要血管事件的关联

2021-09-27 MedSci原创 MedSci原创

Hs-cTnT水平与轻度卒中或TIA后三年内发生的MACE相关,可能有助于识别高风险个体,根据ABCD2评分则被视为低风险个体。

近日,神经病学领域权威取杂志Annals of Neurology上发表了一篇研究文章,这项研究旨在调查高敏心肌肌钙蛋白 T (hs-cTnT) 是否与轻度卒中或短暂性脑缺血发作(TIA)患者的主要不良血管事件(MACE)相关,以及这种关联在基于“年龄、血压、临床特征、症状持续时间、糖尿病”(ABCD2)评分进行风险分层后是否有所不同。

INSPiRE-TMS研究是一项随机对照试验,研究人员将轻度卒中或TIA患者分配到强化支持计划或常规治疗中。在此事后分析中,根据参与者hs-cTnT水平(参考值上限[URL]为14ng/L)进行分类。研究人员使用ABCD2评分对血管风险进行分层(低风险:0-5与高风险:6-7),并使用协变量调整和倾向评分匹配(PSM)对hs-cTnT和MACE(卒中/非致命冠状动脉事件/血管死亡)之间的关联进行Cox比例风险回归。

在889名患者(平均年龄为70岁,37%为女性)中,153名患者(17.2%)在平均3.2年的随访期间发生了MACE。Hs-cTnT与MACE相关(9.3%/年>URL与4.4%/年≤URL,调整后HR为1.63[95%CI为1.13-2.35],调整后HR(Q4与Q1)为2.57[95%CI为1.35-4.97],调整后的HR(对数转换)为2.31[95%CI为1.37-3.89])。

这种关联在PSM后仍然存在(调整后的HR为1.76[95%CI为1.14-2.72])。对于MACE的发生,hs-cTnT和ABCD2类别之间存在显著的相互作用(相互作用p=0.04)。在低危组中,hs-cTnT>URL患者的MACE率为9.5%/年,高于≤URL的患者(3.8%/年),与高危组的总体发生率相似。

由此可见,Hs-cTnT水平与轻度卒中或TIA后三年内发生的MACE相关,可能有助于识别高风险个体,根据ABCD2评分则被视为低风险个体。如果在独立验证研究中得到证实,这可能需要对hs-cTnT升高的卒中患者加强二级预防措施和心脏诊断

原始出处:

Simon Hellwig.et al.Cardiac troponin and recurrent major vascular events after minor stroke or TIA.Annals of Neurology.2021.https://doi.org/10.1002/ana.26225

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    2022-01-22 yinhl1978
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    2021-10-04 1def6e10m76(暂无匿称)

    #脑梗死#Hs-cTnT水平与轻度卒中或TIA后三年内发生的MACE相关,可能有助于识别高风险个体,根据ABCD2评分则被视为低风险个体

    0

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