在穿皮冠状动脉干预中,在已确定的风险标志物中,基线C反应蛋白升高的增量预后值
D P Chew1, D L Bhatt, M A Robbins
1Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Circulation
|August 29, 2001
概括
穿皮冠状动脉干预前C-反应蛋白升高表明30天内死亡或心肌梗塞的风险较高. 将炎症标志物与临床因素结合起来,可以改善接受冠状动脉手术的患者的风险预测.
科学领域:
- 心脏病学 心脏病学
- 炎症和心血管疾病.
- 干预心脏病学 干预心脏病学
背景情况:
- 传统的穿皮冠状动脉干预 (PCI) 风险评估依赖于临床和解剖学因素.
- 越来越多的证据凸显了炎症在冠状动脉疾病结果中的重要作用.
- 炎症标志物可能提供超出已确定的风险预测指标的额外预后信息.
研究的目的:
- 评估基线C反应蛋白 (CRP) 与PCI后30天不良事件的相关性.
- 评估CRP的预测价值与现有的临床和血管学风险因素相结合.
- 确定是否纳入CRP可以改善PCI患者的风险分层模型.
主要方法:
- 对727名接受皮肤冠状动脉再血管化治疗的患者的单一中心注册的分析.
- 在PCI之前评估基线C-反应蛋白水平.
- 评估CRP水平与30天内死亡或心肌梗塞综合终点之间的关联.
- 开发和验证一个包含CRP,病变特征和临床表现的预测模型.
主要成果:
- 基线C反应蛋白升高与30天死亡或心肌梗塞的风险显著增加有关 (最高和最低四分位数:14.2%和3.9%,P=0.002).
- 基线CRP独立预测了不良事件,最高四分位数的几率比为3.68 (95% CI,1.51-8.99;P=0.004).
- 包括CRP,病变得分,急性冠状动脉综合征和支架在内的预测模型显示出强大的预测效用 (C统计,0.735).
结论:
- 升高的基线C反应蛋白是冠状动脉干预后30天风险增加的重要预测因素.
- 将CRP等炎症标志物与解剖学和临床数据相结合,可以提高风险分层的准确性.
- 这种综合方法可以帮助指导PCI患者的治疗策略.
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