hs-cTnT与慢性冠状动脉综合征患者PCI术后发生主要不良心血管事件的关联及其预测阈值分析  

Predictive value of serum hs-cTnT levels for major adverse cardiovascular events in patients with chronic coronary syndrome after PCI

作　　者：许雅鑫 刘茹 王启哲 李小攀 戴宇翔 彭明辉[1] 江孙芳[1,2] Xu Yaxin;Liu Ru;Wang Qizhe;Li Xiaopan;Dai Yuxiang;Peng Minghui;Jiang Sunfang(Department of Health Management Center,Zhongshan Hospital of Fudan University,Shanghai 200032,China;Department of General Practice,Zhongshan Hospital of Fudan University,Shanghai 200032,China;Department of Cardiology,Zhongshan Hospital of Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院健康管理中心,上海200032 [2]复旦大学附属中山医院全科医学科,上海200032 [3]复旦大学附属中山医院心血管内科,上海200032

出　　处：《中华全科医师杂志》2024年第10期1029-1036,共8页Chinese Journal of General Practitioners

基　　金：上海市加强公共卫生体系建设三年行动计划(2023—2025年)(GWVI-11.1-44)。

摘　　要：目的探讨高敏心肌肌钙蛋白T(hs-cTnT)与慢性冠状动脉综合征(CCS)患者经皮冠状动脉介入治疗(PCI)术后发生主要不良心血管事件(MACE)的关联及其预测阈值。方法该研究为病例对照研究。回顾性纳入2019年5月至2020年4月于复旦大学附属中山医院住院行PCI术的CCS患者,根据随访过程中是否发生MACE分为MACE组和对照组。收集入选者基线临床资料,包括术前及术后48 h内的hs-cTnT等。通过门诊或电话进行随访,每位入选者至少随访1次,随访截止时间为2023年2月。终点事件为包括心血管死亡、非心血管死亡、非致死性心肌梗死、不稳定性心绞痛住院治疗、非致死性卒中、心力衰竭、冠状动脉血运重建和支架内血栓形成等在内的MACE。采用X-tile软件分析术后48 h内hs-cTnT峰值预测MACE的截断值,采用Cox回归模型分析术后48 h内hs-cTnT峰值与MACE的关联,采用净重分类指数(NRI)比较不同水平的hs-cTnT对MACE的预测效应。结果入选患者731例,年龄(64.05±9.48)岁,男性560例(76.61%)。中位随访时间29.9(18.8,35.3)个月,期间216例发生MACE(MACE组),未发生MACE者515例(对照组)。X-tile软件分析结果显示PCI术后48 h内hs-cTnT峰值与MACE关联的最佳截断值为4.17×参考值上限(URL)(P=0.033)。多因素Cox回归分析结果显示术后48 h内hs-cTnT峰值>6×URL是CCS患者PCI术后发生MACE的独立危险因素(HR=1.87,95%CI:1.19~2.94,P=0.007)。NRI两两比较结果显示,hs-cTnT>6×URL预测CCS患者PCI术后发生MACE的效应优于>7×URL、8×URL、9×URL、10×URL和15×URL(均P<0.05),预测效应最优。结论术后48 h内hs-cTnT峰值>6×URL是CCS患者PCI术后发生MACE的独立危险因素,且是预测此类患者PCI术后发生MACE的最佳阈值。Objective To investigate the correlation of serum high-sensitivity cardiac troponin T(hs-cTnT)level with major adverse cardiovascular events(MACE)in patients with chronic coronary syndrome(CCS)undergoing percutaneous coronary intervention(PCI)and to explore its predictive value.Methods It was a case-control study.Clinical data of 731 patients with CCS who underwent PCI in the Affiliated Zhongshan Hospital of Fudan University between May 2019 and April 2020 were retrospectively analyzed.Baseline clinical characteristics and pre/postoperative laboratory results were gathered,and patients were followed up and the incidence of MACE was documented.The correlation of serum hs-cTnT levels with MACE was analyzed,and the threshold of hs-cTnT for predicting the occurrence of MACE was determined.Results Among 731 patients there were 560 males(76.61%)with the age of(64.05±9.48)years.Patients were followed up for 29.9(18.8,35.3)months,and MACE occurred in 216 cases(MACE group),and did not occur in 515 cases(control group).The X-tile software analysis showed that the optimal cutoff value of post-PCI hs-cTnT was 4.17×upper reference limit(URL)for predicting MACE(P=0.033).Multivariate Cox regression analysis revealed that postoperative cTnT>6×URL was an independent risk factor for MACE in CCS patients after PCI(HR=1.87,95%CI:1.19-2.94,P=0.007).The net reclassification index pairwise comparison results indicated that hs-cTnT>6×URL had the better predictive performance for MACE in CCS patients after PCI compared to 7×URL,8×URL,9×URL,10×URL and 15×URL(all P<0.05).Conclusion Postoperative hs-cTnT>6×URL is an independent risk factor for MACE in CCS patients after PCI,and hs-cTnT>6×URL is the optimal threshold for predicting the risk of MACE.

关 键 词：冠状动脉疾病 肌钙蛋白T 血管成形术 经腔 经皮冠状动脉 预后 

分 类 号：R541.4[医药卫生—心血管疾病]