Association Between All-Cause Mortality and High-Sensitivity Cardiac Troponin Concentrations in Patients With Chest
Frank H Annie1, Joshua Kepfinger2, Fatima Ahmed2
1CAMC, Health Education and Research Institute, Charleston, WV, USA.
Insights
This study examined troponin levels and mortality in chest pain patients. Elevated troponin levels, even weakly positive ones, were associated with increased all-cause mortality risk.
Area of Science:
- Cardiology
- Biomarkers
- Emergency Medicine
Background:
- Chest pain is a common emergency department presentation.
- Troponin levels are crucial biomarkers for diagnosing myocardial infarction.
- Existing troponin cutoff values may require refinement for diverse populations.
Purpose of the Study:
- To evaluate the association between varying high-sensitivity troponin I (HSTNI) levels and all-cause mortality.
- To establish novel cutoff values for HSTNI in patients presenting with chest pain.
- To compare mortality risks across different troponin level categories.
Main Methods:
- Retrospective cohort study of adult patients with chest pain (ICD-10 R07) at CAMC (June 2020-June 2021).
- Patients categorized into negative, weakly positive, and strongly positive HSTNI groups based on novel sex-specific and general cutoffs.
- Propensity score matching analysis compared mortality at 30 days and 6 months between positive and negative troponin groups, controlling for covariates.
Main Results:
- Patients with weakly positive and strongly positive troponin levels exhibited increased all-cause mortality compared to those with negative levels.
- The study identified specific novel cutoff values for HSTNI.
- Propensity score matching confirmed the association between elevated troponin and mortality risk.
Conclusions:
- Elevated troponin levels, including those previously considered weakly positive, are significantly associated with increased all-cause mortality in chest pain patients.
- The proposed novel HSTNI cutoffs may improve risk stratification.
- Further research is warranted to validate these findings and refine troponin-based clinical decision-making.
Abstract:
We assessed the association between troponin levels and all-cause mortality in individuals with chest pain who presented to the Charleston Area Medical Center Emergency Department (CAMC). We identified adult patients with chest pain as defined in the International Classification of Diseases 10 (R07) family group from the CAMC data warehouse between June 6, 2020, and June 6, 2021. These cases required a visit to the emergency room. We created 3 different cohorts to assess the endpoints of all-cause mortality at 30 days and 6 months. Patients were divided into the following 3 categories: negative troponin level, defined as high sensitivity troponin I (HSTNI) assay ≤15 pg/mL for women and ≤20 pg/mL for men; weakly positive, 21-88 pg/mL for men and 16-88 pg/mL for women; and strongly positive, >88 pg/mL for men and women. A propensity score matching analysis was also conducted using the negative group as a control; the weakly and strongly positive groups were compared to the control across differing cardiology covariates. This study introduces novel cutoffs for high-sensitivity troponin I (Beckman Coulter assay, Beckman Coulter, Inc., Chaska Campus, 1000 Lake Hazeltine Drive, Chaska, Minnesota 55318).
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