急性心力衰竭与心肌肌钙蛋白指数的关系与临床结果分析（英文）.ppt

Background Cardiac troponin provides diagnostic and prognostic information in acute coronary syndromes, but its role in acute decompensated heart failure is unclear. The purpose of our study was to describe the association between elevated cardiac troponin levels and adverse events in hospitalized patients with acute decompensated heart failure. With the use of data from the Acute Decompensated Heart Failure National Registry (ADHERE), we analyzed outcomes associated with elevated troponin levels in patients with acute decompensated heart failure.Briefly,ADHERE is an observational registry, involving patients with an ultimate discharge diagnosis of acute decompensated heart failure. Methods We examined records from 274 hospitals, from October 2001 through January 2004. Inclusion criteria were hospitalization and documentation of the measurement of cardiac troponin I or cardiac troponin T at the initial evaluation (defined as within 24 hours after admission). Because renal dysfunction may influence cardiac troponin concentrations, patients with a serum creatinine level higher than 2.0 mg per deciliter (176.8 μmol per liter) were excluded from the study. A positive troponin test was defined as a cardiac troponin I level of 1.0 μg per liter or higher or a cardiac troponinT level of 0.1 μg per liter or higher. Methods Measurement of cardiac troponin T is performed on a uniform platform in the United States, and the cutoff point of 0.1 μg per liter or higher. Because troponin I has different cutoff points that are dependent on the platform used (more than a dozen different assays), a predefined cutoff point was set at 1.0 μg per liter or higher. This cutoff point was based on expert consensus, approximating values defined from a ROC curve that was optimized for the detection of myocardial infarction. Methods The primary outcome was in-hospital mortality from all causes, and the secondary outcomes included differences in medical management, pro