Elevated baseline cardiac troponin levels in the elderly - another variable to consider?
Ian G Webb1, S T Yam2, Russel Cooke3
1Wellington Cardiovascular Research Group, Wellington, New Zealand; Department of Cardiology, Wellington Hospital, Wellington, New Zealand.
Insights
Elevated high-sensitivity troponin T (hs-TnT) is common in older adults visiting the emergency department without acute coronary syndromes. This elevation is independent of other health conditions, highlighting age as a key factor.
Area of Science:
- Cardiology
- Emergency Medicine
- Biomarker Research
Background:
- Baseline high-sensitivity troponin T (hs-TnT) levels can be present in individuals without acute conditions.
- Understanding troponin T elevation in diverse age groups is crucial for accurate diagnosis in emergency settings.
- The influence of comorbidities on troponin T levels requires further investigation, especially in older populations.
Purpose of the Study:
- To determine the frequency of elevated hs-TnT in different age groups presenting to the Emergency Department (ED).
- To assess patients without acute coronary syndromes (ACS) or other acute illnesses causing troponin elevation.
- To investigate if the association between age and hs-TnT is independent of comorbidities.
Main Methods:
- Retrospective analysis of ED patient data where hs-TnT was measured (November 2010 - June 2011).
- Exclusion of patients with ACS or other acute conditions known to elevate troponin.
- Recording of demographics, clinical characteristics, diagnoses, and hs-TnT assay results.
Main Results:
- Elevated hs-TnT (>14ng/L) increased with age: 1.8% (<50 years), 7.3% (50-69 years), and 41.5% (≥70 years).
- Age over 70 was the strongest independent predictor of elevated hs-TnT (p<0.001).
- Other independent predictors included atrial fibrillation, age 50-69, male gender, heart failure, and ischemic heart disease.
Conclusions:
- Elevated hs-TnT levels are frequent in elderly ED patients without ACS or other acute illnesses.
- This age-related elevation appears independent of the increased comorbidity burden in older individuals.
- Findings suggest age itself is a significant factor in baseline hs-TnT levels, irrespective of acute conditions.
Aims:
This study aimed to determine the frequency of baseline high-sensitivity troponin T (hs-TnT) elevation in different age groups presenting to the Emergency Department without acute coronary syndromes (ACS) or other acute illnesses known to cause to troponin elevation. We additionally sought to determine whether the relationship between age and hs-TnT was independent of co-morbidities.
Methods:
We retrospectively analysed data on all patients presenting to the Emergency Department (ED) between November 2010 and June 2011 in whom hs-TnT was measured. Patients presenting with acute coronary syndromes (ACS) or other acute illness known to elevate hs-TnT levels were excluded. Demographics, clinical characteristics and diagnosis were recorded, together with hs-TnT assay results.
Results:
Of 3219 patients with hs-TnT testing in the ED during the study period, 526 with proven/suspected ACS and 1376 with other acute medical conditions known to elevate troponin concentrations were excluded. The percentage of patients with hs-TnT concentrations elevated above the upper reference limit (>14ng/L) increased with age: <50 years (1.8%), 50-69 years (7.3%), ≥70 years (41.5%), p=0.001. Multivariate analysis identified age over 70 years (p<0.001) as the strongest independent predictor of elevated hs-TnT. Other independent predictors included atrial fibrillation (p<0.001), age 50-69 years (p<0.001) male gender (p<0.001), previous heart failure (p<0.007) and previous ischaemic heart disease (p<0.04).
Conclusions:
Hs-TnT elevations (>14ng/L) are common in elderly patients presenting to the ED without ACS or other acute illnesses known to cause to troponin elevation. This finding appears to be independent of the higher burden of co-morbidities in this age group.
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