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Cardiac Troponin, Kidney Function, Heart Failure and Mortality After Myocardial Infarction in Patients With and
Daniel Murphy1, Sami Firoozi2, Charles A Herzog3
1Cardiology Clinical Academic Group, Institute of Medical and Biomedical Education, St George's, University of London, Cranmer Terrace, London, United Kingdom; Department of Renal and Transplant Medicine, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, United Kingdom.
Insights
Cardiac troponin T levels and kidney function (eGFR) independently predict heart failure and death after myocardial infarction (MI). This finding is crucial for managing MI patients with impaired kidney function.
Area of Science:
- Cardiology
- Nephrology
- Clinical Medicine
Background:
- Cardiac troponins (cTn) are vital for diagnosing myocardial infarction (MI).
- The interplay between troponin levels, kidney function (estimated glomerular filtration rate - eGFR), and outcomes like heart failure (HF) and mortality in MI patients remains unclear, particularly in those with renal impairment.
Purpose of the Study:
- To investigate the relationship between troponin levels, eGFR, and the incidence of acute heart failure (HF) and inpatient mortality in patients with type I MI.
- To identify independent predictors of HF severity and mortality in MI patients, considering varying degrees of kidney function.
Main Methods:
- Retrospective, cross-sectional study analyzing 2,815 patients with type I MI from January 2019 to December 2021.
- Utilized ordinal and binary logistic regression to assess predictors of acute HF (Killip class) and inpatient mortality.
- Analyzed peak cardiac troponin T (cTnT) levels and eGFR as key variables.
Main Results:
- Elevated troponin levels and impaired eGFR (<60 ml/min/1.73 m²) were independently associated with increased risk of acute HF and inpatient mortality.
- Multivariate analysis identified log-transformed peak cTnT and eGFR as significant predictors of HF severity and death.
- eGFR, MI diagnosis type, BMI, gender, diabetes, and hypertension predicted peak cTnT levels post-MI.
Conclusions:
- Peak cTnT levels and eGFR at presentation are independent predictors of acute HF severity and mortality in MI patients, irrespective of kidney function.
- These findings highlight the importance of assessing both troponin and renal function for risk stratification and management of MI patients.
Abstract:
Cardiac troponins (cTn) are routinely measured for the diagnosis and prognosis of myocardial infarction (MI). The relation between troponin levels, estimated glomerular filtration rate (eGFR), postinfarction heart failure (HF), and mortality is unclear in patients with kidney impairment. This is a retrospective, cross-sectional study of patients presenting to the Emergency Department at a single tertiary center. Participants presenting with confirmed type I MI from January 1, 2019, to December 31, 2021, were analyzed from the Myocardial Ischemia National Audit Project database. Main outcomes were acute HF, measured using Killip class, and inpatient mortality. Peak cardiac troponin T (cTnT) level was a secondary outcome. Data on 2,815 patients (67±14 years, 28% female) were analyzed. Ordinal logistic regression analysis was used to test for predictors of increasing Killip class. Binary logistic regression was used to test for predictors of inpatient mortality. Analysis of a sub-sample matched for age and diabetes mellitus status showed increased mortality in patients with eGFR <60 ml/min/1.73 m2 (12.2% vs 4.4%, p <0.001). Multivariate predictors of acute HF included log-transformed peak cTnT, eGFR, body mass index (BMI), and diabetes mellitus status. Multivariate predictors of inpatient mortality included log-transformed peak cTnT, eGFR, age, BMI, and Killip class 3/4. On multivariate analysis, eGFR, ST-elevation MI diagnosis, BMI, male gender, diabetes mellitus status, and hypertension were all predictive of peak cTnT after MI. In conclusion, peak cTnT level and eGFR at presentation after MI are independent predictors of acute HF severity and death in patients with and without kidney impairment.
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