入院时肌钙蛋白I水平在急性心肌梗死直接经皮冠状动脉介入干预患者危险分层与预后预测中的价值

The values of admission cardiac troponin I levels in risk stratification and outcomes evaluation in patients with acute myocardial infarction referred to primary percutaneous coronary intervention

目的 探讨入院时肌钙蛋白I(TnI)水平在急性心肌梗死直接经皮冠状动脉介入干预(PCI)患者危险分层与预后预测中的价值。方法 连续行直接PCI的 15 6例ST段抬高的急性心肌梗死 (STEMI)患者根据入院时TnI水平分成TnI阳性组 (89例 )和TnI阴性组 (6 7例 ) ,观察患者临床特征 ,并随访 (平均 7 3± 3 2个月 )主要心血管事件 (MACE)。结果 与TnI阴性组比较 ,TnI阳性组高龄患者较多 ,发病至再灌注时间延长 ,左室射血分数 (LVEF)明显下降 (P均 <0 0 5 ) ;其直接PCI后 2h仍有持续性ST段抬高者较多 (P <0 0 5 ) ,直接PCI成功率降低 (P <0 0 5 )。两组间总心脏性死亡率差异无显著性 ,但TnI阳性组总MACE事件 (包括非致命性再次心肌梗死、靶血管血运重建及心脏性病死率之和 )发生率显著增加 (2 2 9%比 9 7% ,P均 <0 0 5 )。结论 入院时血TnI水平与总MACE发生率增加密切相关 (OR值 :8 6 ,95 %可信区间 :2 1～ 38 4 ,P <0 0 5 ) ,且它是除年龄大于 70岁与LVEF值变量外另一个预测STEMI患者直接PCI后总MACE发生率增高、无MACE存活率降低危险的独立预测因子。

Objective To investigate the values of admission cardiac troponin I (TnI) levels in risk stratification outcomes evaluation in patients with acute myocardial infarction referred to primary percutaneous coronary intervention (PCI). Methods Consecutive one hundred and fifty six cases with ST elevation myocardial infarction (STEMI) who underwent primary PCI were divided into 2 groups: TnI-positive group (89 cases) and TnI-negative group(67 cases) according to the admission TnI levels. The clinical characteristics and major cardiovascular events(MACE) at follow-up period of a mean 7.3±3.2 months were analysed. Results The percentage of older patients were higher, and symptom-onset to balloon time delayed as well as left ventricular ejection fraction(LVEF) decreased in TnI-positive group compared with those in TnI-negative group(all P <0.05). In TnI-positive group, the proportion of patients with persistent ST-segment elevation 2 hours after primary PCI was higher but the success rate of patients undergoing primary PCI was lower than these in TnI-negative group(all P <0.05). Cardiac mortality rate was similar in the 2 groups, however, total rates of MACE(including overall incidences of non-fatal myocardial infarction, revascularization of target vessel and cardiac death) significantly increased in TnI-positive group than that in TnI-negative group(22.9% vs 9.7%, P <0.05). Conclusion Admission serum TnI level was associated with the increases in overall incidences of MACE and it was respectively an another independent predictor for higher total rates of MACE and lower MACE-free survival rate besides age(>70 years) and LVEF value in patients with STEMI treated by primary PCI.