Prevalence, Determinants, and Clinical Associations of High-Sensitivity Cardiac Troponin in Patients Attending Emergency Departments - 19/12/18
, Ala Noaman, MD a, Amar Vaswani, MD a, Matthew Gibbins a, Megan Griffiths, BSc a, Andrew R. Chapman, MD a, Fiona Strachan, PhD a, Atul Anand, MD a, David A. McAllister, MD, MPH, PhD b, David E. Newby, MD, PhD a, Alasdair J. Gray, MD c, d, Nicholas L. Mills, MD, PhD a, Anoop S.V. Shah, MD, MPH, PhD aAbstract |
Background |
High-sensitivity cardiac troponin assays may improve the diagnosis of myocardial infarction but increase the detection of elevated cardiac troponin in patients without acute coronary syndrome.
Methods |
In a prospective cohort study, we evaluated the prevalence, determinants, and outcome of patients with elevated cardiac troponin attending the emergency department without suspected acute coronary syndrome. We measured high-sensitivity cardiac troponin in 918 consecutive patients attending the emergency department without suspected acute coronary syndrome who had blood sampling performed by the attending clinician. Elevated high-sensitivity cardiac troponin I was defined as concentrations above the sex-specific 99th percentile threshold. Clinical demographics, physiological measures, and all-cause mortality at 1 year associated with elevated high-sensitivity cardiac troponin concentrations were recorded.
Results |
Elevated cardiac troponin concentration occurred in 114 (12.4%) patients, of whom 2 (0.2%), 3 (0.3%), and 109 (11.9%) were adjudicated as type 1 myocardial infarction, type 2 myocardial infarction, and myocardial injury, respectively. Elevated troponin concentrations were associated with increasing age, worsening renal function, multimorbidity, and adverse physiology. Across a total of 912 patient-years follow-up, cardiac troponin concentration was a strong predictor of death (hazard ratio [HR] 1.26 per 2-fold increase, 95% confidence interval [CI] 1.06 to 1.49) independent of age, sex, multimorbidity, and adverse physiology.
Conclusions |
High-sensitivity cardiac troponin concentrations were elevated in 1 in 8 consecutive patients without suspected acute coronary syndrome attending the emergency department and were associated with increasing age, multimorbidity, adverse physiology, and death. Elevated cardiac troponin in unselected patients predominantly reflects myocardial injury rather than myocardial infarction.
El texto completo de este artículo está disponible en PDF.Key words : Acute coronary syndrome, Diagnosis, High-sensitivity cardiac troponin, Myocardial infarction, Myocardial injury
Esquema
| Funding: Support was provided by British Heart Foundation Research Training Fellowship (FS/18/25/33454), Special Project Grant (SP/12/10/29922), Senior Fellowship (FS/16/75/32533) and Chair Award (CH/09/002) |
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| Conflicts of Interest: NLM has received consultancy, research grants, and speaker fees from manufacturers of cardiac troponin testing including Abbott Diagnostics, Roche, and Singulex. |
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| Authorship: All authors confirm equal access to the data and a role in writing this manuscript. |
Vol 132 - N° 1
P. 110.e8-110.e21 - janvier 2019 Regresar al número
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