在到院後90分鐘內進行立即性血管介入性治療的ST時段上升心肌梗塞病患其起始肌鈣蛋白-I的上升與高死亡率和低左心室射出率相關

Initial Elevated Troponin I Is Associated With Mortality and Left Ventricular Ejection Fraction in Patients with STEMI Post Primary Percutaneous Coronary Intervention within 90 Minutes of Arrival

陳輔政(Fu-Cheng Chen)

指導教授 ： 王姿乃

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2013年)

https://doi.org/10.6832/KMU.2013.00014

摘要

目的：評估在到院後90分鐘內進行立即血管介入性治療的ST時段上升心肌梗塞病患其起始肌鈣蛋白-I對30天內死亡率和左心室射出率的影響。
方法：從2011年1月至2011年12月，收錄135位胸痛發作<12小時的ST時段上升心肌梗塞接受立即性血管介入性治療的病患。病患分為起始肌鈣蛋白-I上升組（≧0.5納克/毫升）和起始肌鈣蛋白-I正常組。
結果：在135例病患中，有44例（33％）其初始肌鈣蛋白-I上升。肌鈣蛋白I的上升與較高的死亡率（14％ vs.2％，P=0.008）和較低的左心室射出率（P=0.001）有相關性。肌鈣蛋白-I與左心室射出率有統計學顯著的負相關（r=0.347，P <0.0001）。我們繪製ROC 曲線預測30天內死亡率，其C-統計量為0.77。 Kaplan-Meier生存曲線中兩組的差異有統計學意義（P=0.008）。以STEMI的TIMI危險評分因子做多元Cox回歸分析校正，顯示肌鈣蛋白-I≧ 0.5納克/毫升（HR = 10.98，95％CI為1.02至118.78）為30天死亡率的獨立預測因子。
結論：肌鈣蛋白-I的上升是此類病患30天內死亡率的獨立預測因子。而且與左心室功能下降有相關性。初始肌鈣蛋白-I對於病患早期危險分類可以做為一個簡單且實用的輔助。

關鍵字

急性心肌梗塞 ； 經皮冠狀動脈介入治療 ； 臨床結果

並列摘要

Background: This study evaluated the impact of admission troponin I on 30-day mortality and left ventricular ejection fraction (LVEF) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) within 90 minutes of arrival.
Methods: Between January 2011 and December 2011, 135 patients who had experienced STEMI with an onset of chest pain < 12 hours of undergoing primary PCI were enrolled. Patients were categorized into initial elevated troponin I group (≧0.5 ng/mL) and initial normal troponin I group.
Results: Of the 135 patients, 44 (33%) patients had initial elevated troponin I. Elevated troponin I was associated with higher mortality (14% vs. 2%, p = 0.008) and a lower LVEF (p = 0.001). A statistically significant inverse correlation between troponin I levels and LVEF was found with a relatively low correlation coefficient (r =0.347, p < 0.0001). We created receiver operating characteristic curves to predict the 30 days mortality and C-statistic was 0.77. The Kaplan-Meier survival curves in the 2 groups were statistically different (P = 0.008 by log-rank test). Multivariate Cox regression analysis adjustment with the variables of TIMI risk score for STEMI showed troponin I > =0.5 ng/mL (HR 10.98, 95% CI 1.02 to 118.78), SBP < 100 mmHg (HR 9.55, 95% CI 1.12 to 81.15), heart rate > 100 beats per minute (HR 6.47, 95% CI 1.18 to 35.47), and age >= 65 years old (HR 6.53, 95% CI 1.20 to 35.48) were independent predictors of the 30-day mortality.
Conclusions: Elevated troponin I is independently predictive of 30-day mortality in patients with STEMI undergoing primary PCI within 90 minutes of arrival. It is associated with decreased left ventricular function. The initial troponin I could be a useful simple adjunct for early risk stratification.

並列關鍵字

Acute myocardial infarction ； Primary percutaneous coronary intervention ； Clinical outcomes

參考文獻

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