在最初血浆肌钙蛋白阴性的非ST段抬高型急性冠状动脉综合征患者中预测后期肌钙蛋白阳性:来自TIMI IIIB和GUSTO IIA研究的临床预测因素和已确定的风险评分结果  

Predicting a late positive serum troponin in initially troponin-negative patients with non-ST-elevation acute coronary syndrome: Clinical predictors and validated risk score results from the TIMI IIIB and GUSTO IIA studies

作　　者：Januzzi Jr. J.L. Newby L.K. Murphy S.A. 孙凯 

机构地区：[1]Massachusetts General Hospital, Yawkey 5800, 55 Fruit Street, Boston, MA 02114, United States Dr.

出　　处：《世界核心医学期刊文摘（心脏病学分册）》2006年第6期13-13,共1页

摘　　要：Background: Troponin testing is useful for evaluating patients with non- ST segment elevation acute coronary syndromes(NSTE ACS); however, a significant ercentage of patients are troponin negative at presentation and develop late rise of the marker. Methods: Patients in the TIMI IIIB study were assessed with respect to their troponin I(TnI) status at presentation and 12 hours. Multivariable analysis identified independent clinical factors associated with TnI rise at 12 hours among subjects initially TnI negative. A score predicting late TnI rise in TIMI IIIB was developed using these factors and validated among patients in the GUSTO IIA study. Results: Of 1342 subjects in TIMI IIIB, 200(14.9% ) were negative at baseline, but developed an elevated TnI(≥ 0.4 ng/mL) at 12 hours. Six independent predictors of late TnI rise were identified: ST- segment deviation(odds ratio [OR] 3.52, 95% CI 2.38- 5.23, P< .001), presentation< 8 hours from symptom onset(OR 2.91, 95% CI 1.92- 4.40, P< .001), no prior percutaneous coronary intervention(OR 2.88, 95% CI 1.54- 5.39, P=.001), no prior β - blocker use(OR 1.74, 95% CI 1.15- 2.63, P=.008), unheralded angina(OR 1.65, 95% CI 1.12- 2.42, P=.01), and a history of myocardial infarction(OR 1.59, 95% CI 1.06- 2.37, P=.02). ST deviation, presentation< 8 hours from symptoms, and no prior percutaneous coronary intervention were given a score of 2 points, whereas a score of 1 point was assigned to the other factors. Among baseline TnI- negative patients, a rising score was paralleled by an increasing prevalence of late TnI rise from 0% (with a score of 0) to 69% (with a score of 9)(P< .001). In confirmation, the score was able to similarly predict late troponin T rise among 855 patients in the GUSTO IIA study(P< .0001). Conclusion: Development of late troponin rise is common in non- ST- segment elevation acute coronary syndromes. Six easily ascertained variables may be used to identify those at higher risk for late rise in troponin levels after an initially negative presentation.Background： Troponin testing is useful for evaluating patients with non-ST-segment elevation acute coronary syndromes（NSTE ACS）; however, a significant percentage of patients are troponin negative at presentation and develop late rise of the marker. Methods： Patients in the TIMI IIIB study were assessed with respect to their troponin I（TnI） status at presentation and 12 hours. Multivariable analysis identified independent clinical factors associated with TnI rise at 12 hours among subjects initially TnI negative. A score predicting late TnI rise in TIMI IIIB was developed using these factors and validated among patients in the GUSTO IIA study. Results： Of 1342 subjects in TIMI IIIB, 200（14. 9% ） were negative at baseline, but developed an elevated TnI（ 〉10. 4 ng/mL） at 12 hours. Six independent predictors of late TnI rise were identified： ST-segment deviation（odds ratio [OR] 3.52, 95% CI 2. 38- 5.23, P 〈 . 001）, presentation 〈 8 hours from symptom onset（OR 2. 91, 95% CI 1.92-4.40, P 〈 . 001）, no prior percutaneous coronary intervention（OR 2.88, 95% CI 1.54-5.39, P=.001）,

关 键 词：急性冠状动脉综合征 肌钙蛋白阳性 非ST段抬高型 TIMI 预测因素 临床因素 IIA 患者 阴性 评分 

分 类 号：R543.3[医药卫生—心血管疾病] R542.22[医药卫生—内科学]