臺灣博碩士論文加值系統

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。

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.

1. Background ………………………………………………………………………1
1.1 Acute coronary syndrome ………………………………………………1
1.2 Primary percutaneous coronary intervention in STEMI…………3
1.3 Cardiac biomarkers …………………………………………………6
1.4 The aim of this study ………………………………………………8
2. Method ……………………………………………………………………………9
2.1 Study population ………………………………………………………9
2.2 Measurement of cardiac troponin I…………………………………11
2.3 Data collection and outcomes………………………………………12
2.4 Statistical Analysis…………………………………………………14
3. Results …………………………………………………………………………16
3.1 Clinical and baseline characteristics …………………………16
3.2 Clinical outcomes ……………………………………………………17
3.3 Multivariate Cox regression analysis ……………………………19
4. Discussion………………………………………………………………………21
4.1 The main findings of our study……………………………………21
4.2 The success of PCI ……………………………………………………23
4.3 The relation of heart rate and troponin I…………………………24
4.4 The relation of troponin I and time of symptom onset……………25
4.5 The troponin I and prognosis………………………………………27
4.6 Study Limitations ……………………………………………………29
5. Conclusion………………………………………………………………………30
6. Reference ………………………………………………………………………31


表目錄
Table 1. Clinical and baseline characteristics…………………………35
Table 2. Clinical outcomes……………………………………………………36
Table 3. TIMI risk score and baseline variables for STEMI………………37
Table 4. Multivariate Cox Regression of significant risk factors……38

圖目錄
Figure 1. Study flow chart of enrollment…………………………………39
Figure 2. Relationship between left ventricular ejection fraction (LVEF) and log troponin I level …………………………………………40
Figure 3. Receiver operating characteristic curves plotting sensitivity by 1-specificity for mortality through 30 days for troponin I …………………………………………………………………………………41
Figure 4. Kaplan-Meier curves of survival probability in patients with initial elevated troponin I (≧0.5 ng/mL) compared with patients with initial normal troponin………………………………………………………42
Figure 5. Distribution of elevated troponin I (≧0.5 ng/mL) and normal troponin I on patients according to time intervals from onset of symptoms to admission…………………………………………………………43
附錄
Appendix 1. Coordinate points of the ROC Curve…………………………44
Appendix 2. Pearson correlations for troponin I, onset to balloon time, heart rate and TIMI score……………………………………………………47
Appendix 3. Collinearity diagnostics………………………………………48

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