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Relation of Chronic Myocardial Injury and Non-ST-Segment Elevation Myocardial Infarction to Mortality

Andreas Roos1, Ulrik Sartipy2, Rickard Ljung3

  • 1Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Functional area of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.

The American Journal of Cardiology
|October 14, 2018
PubMed

Insights

Patients with chest pain and chronic myocardial injury have varying long-term risks. Stable high-sensitivity cardiac troponin T (hs-cTnT) levels of ≥30 ng/L indicate increased mortality risk compared to non-ST-segment elevation myocardial infarction (NSTEMI).

Area of Science:

  • Cardiology
  • Biomarkers
  • Prognostic Studies

Background:

  • Prognosis for chest pain patients with chronic myocardial injury is unclear.
  • Comparison with non-ST-segment elevation myocardial infarction (NSTEMI) outcomes is needed.
  • High-sensitivity cardiac troponin T (hs-cTnT) is a key cardiac biomarker.

Purpose of the Study:

  • To compare long-term outcomes of patients with chest pain and chronic myocardial injury versus NSTEMI.
  • To investigate the association between stable hs-cTnT levels and mortality, myocardial infarction, and heart failure.
  • To establish risk stratification based on hs-cTnT levels.

Main Methods:

  • Retrospective cohort study of 20,387 patients from Karolinska University Hospital (2011-2014).
  • Comparison of patients with NSTEMI against those with stable hs-cTnT levels.
  • Hazard ratios calculated for all-cause mortality, MI, and heart failure, with NSTEMI as referent.

Main Results:

  • Patients with chronic myocardial injury (stable hs-cTnT ≥30 ng/L) had higher all-cause mortality risk (aHR 1.65-2.13) versus NSTEMI.
  • Lower hs-cTnT levels (<15 ng/L) were associated with reduced heart failure risk.
  • All stable hs-cTnT levels correlated with a lower risk of myocardial infarction (MI).

Conclusions:

  • Chest pain patients with stable hs-cTnT 10-29 ng/L show similar risk to NSTEMI.
  • Chronic myocardial injury with hs-cTnT ≥30 ng/L signifies increased long-term mortality risk.
  • hs-cTnT levels aid in risk stratification for patients with chest pain.

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