医学
利钠肽
内科学
置信区间
肌钙蛋白T
心力衰竭
人口
相对风险
肌钙蛋白
心脏病学
胃肠病学
内分泌学
心肌梗塞
环境卫生
作者
Alberto Aimo,James L. Januzzi,Christian Mueller,Òscar Miró,Domingo A. Pascual‐Figal,Javier Jacob,Pablo Herrero‐Puente,Pere Llorens,Desiree Wussler,Nikola Kozhuharov,Zaid Sabti,Tobias Breidthardt,Giuseppe Vergaro,Andrea Ripoli,Concetta Prontera,Luigi F. Saccaro,Claudio Passino,Michele Emdin
标识
DOI:10.1016/j.ijcard.2019.06.005
摘要
Background High-sensitivity troponin T (hs-TnT) reflects the severity of ongoing myocardial damage. In acute heart failure (AHF), its additive prognostic value over B-type natriuretic peptides is unclear. Methods Individual data of 1499 AHF patients with admission hs-TnT were collected from 3 cohorts. Results Patients (78 ± 10 years, 51% men, N-terminal fragment of pro-B-type natriuretic peptide – NT-proBNP - 5660 [2693–12,466], hs-TnT 43 ng/L [26–69]) experiencing in-hospital death (n = 187, 13%) had significantly higher hs-TnT and NT-proBNP on admission (both p < 0.001). Patients with hs-TnT ≥43 ng/L and NT-proBNP ≥5660 ng/L had a 2.7-fold higher risk of in-hospital death (relative risk - RR 2.7, 95% confidence interval - CI 1.7–4.5). Among discharged patients, 1024 deaths (81%) occurred over 11 months (4–22). In the whole population, hs-TnT ≥43 ng/L predicted all-cause death at 6, 12 and 24 months independently from NT-proBNP ≥5660 ng/L. The best NT-proBNP cut-off for in-hospital mortality (4382 ng/L) independently predicted this endpoint, while the best hs-TnT cut-off (55 ng/L) did not. Patients with NT-proBNP ≥4382 ng/L and hs-TnT ≥55 ng/L had a 12-fold higher risk of in-hospital death (RR 11.7, 95% CI 6.9–19.7). The best hs-TnT cut-offs independently predicted all post-discharge outcomes. Conclusions The best NT-proBNP cut-off (4382 ng/L) independently predicts outcome, while the best hs-TnT (55 ng/L) does not; patients with both biomarkers ≥best cut-offs have a 12-fold higher risk of in-hospital mortality. Admission hs-TnT ≥43 ng/L and the best hs-TnT cut-offs hold independent prognostic significance for post-discharge outcome, while hs-TnT seems less predictive than NT-proBNP when considering absolute values.
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