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【文摘发布】NEJM 心肌肌钙蛋白与急性心力衰竭的
W. Frank Peacock, IV, M.D., Teresa De Marco, M.D., Gregg C. Fonarow, M.D., Deborah Diercks, M.D., Janet Wynne, M.S., Fred S. Apple, Ph.D., Alan H.B. Wu, for the ADHERE Investigators
ABSTRACT
Background Cardiac troponin provides diagnostic and prognostic information in acute coronary syndromes, but its role in acute decompensated heart failure is unclear. The purpose of our study was to describe the association between elevated cardiac troponin levels and adverse events in hospitalized patients with acute decompensated heart failure.
Methods We analyzed hospitalizations for acute decompensated heart failure between October 2001 and January 2004 that were recorded in the Acute Decompensated Heart Failure National Registry (ADHERE). Entry criteria included a troponin level that was obtained at the time of hospitalization in patients with a serum creatinine level of less than 2.0 mg per deciliter (177 µmol per liter). A positive troponin test was defined as a cardiac troponin I level of 1.0 µg per liter or higher or a cardiac troponin T level of 0.1 µg per liter or higher.
Results Troponin was measured at the time of admission in 84,872 of 105,388 patients (80.5%) who were hospitalized for acute decompensated heart failure. Of these patients, 67,924 had a creatinine level of less than 2.0 mg per deciliter. Cardiac troponin I was measured in 61,379 patients, and cardiac troponin T in 7880 patients (both proteins were measured in 1335 patients). Overall, 4240 patients (6.2%) were positive for troponin. Patients who were positive for troponin had lower systolic blood pressure on admission, a lower ejection fraction, and higher in-hospital mortality (8.0% vs. 2.7%, P<0.001) than those who were negative for troponin. The adjusted odds ratio for death in the group of patients with a positive troponin test was 2.55 (95% confidence interval, 2.24 to 2.89; P<0.001 by the Wald test).
Conclusions In patients with acute decompensated heart failure, a positive cardiac troponin test is associated with higher in-hospital mortality, independently of other predictive variables. (ClinicalTrials.gov number, NCT00366639 [ClinicalTrials.gov] .)
Cardiac Troponin and Outcome in Acute Heart Failure
W. Frank Peacock, IV, M.D., Teresa De Marco, M.D., Gregg C. Fonarow, M.D., Deborah Diercks, M.D., Janet Wynne, M.S., Fred S. Apple, Ph.D., Alan H.B. Wu, for the ADHERE Investigators
心肌肌钙蛋白与急性心力衰竭的预后
ABSTRACT
摘要
Background Cardiac troponin provides diagnostic and prognostic information in acute coronary syndromes, but its role in acute decompensated heart failure is unclear. The purpose of our study was to describe the association between elevated cardiac troponin levels and adverse events in hospitalized patients with acute decompensated heart failure.
背景：心肌肌钙蛋白为急性冠脉综合症提供诊断和预后信息，但是它在失代偿性心力衰竭中的地位尚不清楚。我们研究的目的是明确心肌肌钙蛋白水平升高与急性失代偿性心力衰竭的住院患者发生不良事件的关系。
Methods We analyzed hospitalizations for acute decompensated heart failure between October 2001 and January 2004 that were recorded in the Acute Decompensated Heart Failure National Registry (ADHERE). Entry criteria included a troponin level that was obtained at the time of hospitalization in patients with a serum creatinine level of less than 2.0 mg per deciliter (177 µmol per liter). A positive troponin test was defined as a cardiac troponin I level of 1.0 µg per liter or higher or a cardiac troponin T level of 0.1 µg per liter or higher.
方法：我们分析了2001年10月-2004年1月之间的国家急性失代偿性心力衰竭登记数据。入选标准是患者入院时的心肌肌钙蛋白水平数据可获得，血清肌酐水平小于2mg/dL（177µmol/L）.肌钙蛋白阳性被定义为心肌肌钙蛋白I水平大于1.0 µg/L活着心肌肌钙蛋白水平大于0.1 µg/L
Results Troponin was measured at the time of admission in 84,872 of 105,388 patients (80.5%) who were hospitalized for acute decompensated heart failure. Of these patients, 67,924 had a creatinine level of less than 2.0 mg per deciliter. Cardiac troponin I was measured in 61,379 patients, and cardiac troponin T in 7880 patients (both proteins were measured in 1335 patients). Overall, 4240 patients (6.2%) were positive for troponin. Patients who were positive for troponin had lower systolic blood pressure on admission, a lower ejection fraction, and higher in-hospital mortality (8.0% vs. 2.7%, P<0.001) than those who were negative for troponin. The adjusted odds ratio for death in the group of patients with a positive troponin test was 2.55 (95% confidence interval, 2.24 to 2.89; P<0.001 by the Wald test).
结果：105388例急性失代偿性心力衰竭住院患者中有84872例患者接受了肌钙蛋白检查。在这些患者中67924例患者肌酐小于2.0mg/L。61379例患者接受了心肌肌钙蛋白I检查，7880例患者接受心肌肌钙蛋白T检查（1335例患者接受了两种蛋白检查）。4240例（6.2%）患者肌钙蛋白阳性。肌钙蛋白阳性的患者与阴性患者相比有较低的入院时收缩压、射血分数和较高的住院死亡率（8.0 % vs 2.7%，P<0.001）。肌钙蛋白阳性患者校正后比值比为2.55(95%可信区间 2.24-2.89，P<0.001 Wald 检验)。
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作者:admin@医学,生命科学 2010-11-22 17:11
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