高灵敏度与常规的热素截止值对于急性肺栓塞患者的风险分层
Behnood Bikdeli1,2,3, Alfonso Muriel4, Carmen Rodríguez5
1Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA cardiology
|November 22, 2023
概括
高灵敏度的热素I (hs-cTnI) 与常规的热素I (cTnI) 相比,没有改善稳定的肺栓塞 (PE) 患者的风险分层. hs-cTnI可能会高估风险,可能导致不必要的干预.
科学领域:
- 心脏病学 心脏病学
- 临床诊断 临床诊断 临床诊断
- 肺部医学 肺部医学
背景情况:
- 高灵敏度托罗邦素I (hs-cTnI) 测定检测到心脏托罗邦素水平低于传统测定.
- 在血液动力稳定性肺栓塞 (PE) 中hs-cTnI对风险分层的临床实用性尚不清楚.
研究的目的:
- 为了比较hs-cTnI与常规的心脏 I (cTnI) 在稳定的PE患者的风险指定.
- 评估热素水平与PE诊断后30天内临床结果之间的关联.
主要方法:
- 对前性多中心PROTECT队列研究的后期分析 (n=834).
- 在PE诊断时cTnI和hs-cTnI测定的比较.
- 欧洲心脏病学会 (ESC) 2019年风险分类和复杂的过程 (血液动力学崩,复发性PE或全因死亡) 的评估.
主要成果:
- 升高的cTnI,但不是hs-cTnI,与复杂病程的几率增加有关 (OR2.84对1.12).
- 患有高hs-cTnI但正常cTnI (n=125) 的患者没有经历过复杂的疗程.
- 与cTnI相比,hs-cTnI将较少的患者归类为低风险患者,可能会高估风险.
结论:
- 在血液动力学稳定的PE中,hs-cTnI与cTnI相比没有为风险分层提供附加的临床价值.
- 研究结果表明,hs-cTnI可能导致该患者群体过度估计风险.
- 需要进一步的研究来澄清hs-cTnI在PE管理中的作用.
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