Rafael Y. Brzezinski PhD, Shmuel Banai MD, Malka Katz Shalhav DMD, Moshe Stark PhD, Ilana Goldiner PhD, Ori Rogowski MD, PhD, Itzhak Shapira MD, David Zeltser MD, Noa Sasson MPH, Shlomo Berliner MD, PhD, Yacov Shacham MD
{"title":"CRP 肌钙蛋白检测(CTT)可对非 ST 段抬高型心肌梗死(NSTEMI)患者的死亡风险进行分层。","authors":"Rafael Y. Brzezinski PhD, Shmuel Banai MD, Malka Katz Shalhav DMD, Moshe Stark PhD, Ilana Goldiner PhD, Ori Rogowski MD, PhD, Itzhak Shapira MD, David Zeltser MD, Noa Sasson MPH, Shlomo Berliner MD, PhD, Yacov Shacham MD","doi":"10.1002/clc.24256","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>The C-reactive protein (CRP)-troponin-test (CTT) comprises simultaneous serial measurements of CRP and cardiac troponin and might reflect the systemic inflammatory response in patients with acute coronary syndrome. We sought to test its ability to stratify the short- and long-term mortality risk in patients with non-ST elevation myocardial infarction (NSTEMI).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We examined 1,675 patients diagnosed with NSTEMI on discharge who had at least two successive measurements of combined CRP and cardiac troponin within 48 h of admission. A tree classifier model determined which measurements and cutoffs could be used to best predict mortality during a median follow-up of 3 years [IQR 1.8–4.3].</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Patients with high CRP levels ( > 90th percentile, >54 mg/L) had a higher 30-day mortality rate regardless of their troponin test findings (16.7% vs. 2.9%, <i>p</i> < 0.01). However, among patients with “normal” CRP levels ( < 54 mg/L), those who had high troponin levels ( > 80th percentile, 4,918 ng/L) had a higher 30-day mortality rate than patients with normal CRP and troponin concentrations (7% vs. 2%, <i>p</i> < 0.01). The CTT test result was an independent predictor for overall mortality even after adjusting for age, sex, and comorbidities (HR = 2.28 [95% CI 1.56-3.37], <i>p</i> < 0.01 for patients with high troponin and high CRP levels).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Early serial CTT results may stratify mortality risk in patients with NSTEMI, especially those with “normal” CRP levels. The CTT could potentially assess the impact of inflammation during myocardial necrosis on the outcomes of patients with NSTEMI and identify patients who could benefit from novel anti-inflammatory therapies.</p>\n </section>\n </div>","PeriodicalId":2,"journal":{"name":"ACS Applied Bio Materials","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24256","citationCount":"0","resultStr":"{\"title\":\"The CRP troponin test (CTT) stratifies mortality risk in patients with non-ST elevation myocardial infarction (NSTEMI)\",\"authors\":\"Rafael Y. Brzezinski PhD, Shmuel Banai MD, Malka Katz Shalhav DMD, Moshe Stark PhD, Ilana Goldiner PhD, Ori Rogowski MD, PhD, Itzhak Shapira MD, David Zeltser MD, Noa Sasson MPH, Shlomo Berliner MD, PhD, Yacov Shacham MD\",\"doi\":\"10.1002/clc.24256\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>The C-reactive protein (CRP)-troponin-test (CTT) comprises simultaneous serial measurements of CRP and cardiac troponin and might reflect the systemic inflammatory response in patients with acute coronary syndrome. We sought to test its ability to stratify the short- and long-term mortality risk in patients with non-ST elevation myocardial infarction (NSTEMI).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We examined 1,675 patients diagnosed with NSTEMI on discharge who had at least two successive measurements of combined CRP and cardiac troponin within 48 h of admission. A tree classifier model determined which measurements and cutoffs could be used to best predict mortality during a median follow-up of 3 years [IQR 1.8–4.3].</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Patients with high CRP levels ( > 90th percentile, >54 mg/L) had a higher 30-day mortality rate regardless of their troponin test findings (16.7% vs. 2.9%, <i>p</i> < 0.01). However, among patients with “normal” CRP levels ( < 54 mg/L), those who had high troponin levels ( > 80th percentile, 4,918 ng/L) had a higher 30-day mortality rate than patients with normal CRP and troponin concentrations (7% vs. 2%, <i>p</i> < 0.01). The CTT test result was an independent predictor for overall mortality even after adjusting for age, sex, and comorbidities (HR = 2.28 [95% CI 1.56-3.37], <i>p</i> < 0.01 for patients with high troponin and high CRP levels).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Early serial CTT results may stratify mortality risk in patients with NSTEMI, especially those with “normal” CRP levels. 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The CRP troponin test (CTT) stratifies mortality risk in patients with non-ST elevation myocardial infarction (NSTEMI)
Introduction
The C-reactive protein (CRP)-troponin-test (CTT) comprises simultaneous serial measurements of CRP and cardiac troponin and might reflect the systemic inflammatory response in patients with acute coronary syndrome. We sought to test its ability to stratify the short- and long-term mortality risk in patients with non-ST elevation myocardial infarction (NSTEMI).
Methods
We examined 1,675 patients diagnosed with NSTEMI on discharge who had at least two successive measurements of combined CRP and cardiac troponin within 48 h of admission. A tree classifier model determined which measurements and cutoffs could be used to best predict mortality during a median follow-up of 3 years [IQR 1.8–4.3].
Results
Patients with high CRP levels ( > 90th percentile, >54 mg/L) had a higher 30-day mortality rate regardless of their troponin test findings (16.7% vs. 2.9%, p < 0.01). However, among patients with “normal” CRP levels ( < 54 mg/L), those who had high troponin levels ( > 80th percentile, 4,918 ng/L) had a higher 30-day mortality rate than patients with normal CRP and troponin concentrations (7% vs. 2%, p < 0.01). The CTT test result was an independent predictor for overall mortality even after adjusting for age, sex, and comorbidities (HR = 2.28 [95% CI 1.56-3.37], p < 0.01 for patients with high troponin and high CRP levels).
Conclusions
Early serial CTT results may stratify mortality risk in patients with NSTEMI, especially those with “normal” CRP levels. The CTT could potentially assess the impact of inflammation during myocardial necrosis on the outcomes of patients with NSTEMI and identify patients who could benefit from novel anti-inflammatory therapies.