Troponin level at presentation as a prognostic factor among patients presenting with non-ST-segment elevation
Ranel Loutati1, Nimrod Perel1, Sharon Bruoha2
1Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Insights
High-sensitivity cardiac troponin (hs-cTn) levels upon admission can identify non-ST-segment myocardial infarction (NSTEMI) patients at higher risk of mortality. Early reperfusion strategies guided by hs-cTn levels may improve outcomes.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Risk Stratification
Background:
- Timely reperfusion is crucial for non-ST-segment myocardial infarction (NSTEMI) patients with high-risk features.
- Limited evidence exists on using admission high-sensitivity cardiac troponin (hs-cTn) for risk-stratifying NSTEMI patients to expedite percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate the association between admission hs-cTn levels and all-cause mortality in NSTEMI patients.
- To assess the utility of hs-cTn in risk-stratifying NSTEMI patients for potential early intervention.
Main Methods:
- Retrospective analysis of 544 NSTEMI patients admitted to a tertiary care ICCU (July 2019-July 2022).
- Patients were stratified into quartiles based on admission hs-cTnI levels.
- Association between hs-cTnI quartiles and 3-year all-cause mortality was analyzed.
Main Results:
- Higher admission hs-cTnI levels were associated with increased all-cause mortality.
- The highest hs-cTnI quartile showed significantly higher mortality (16.2%) compared to the lowest (7.35%, p=0.03).
- Adjusted hazard ratio for mortality in the highest quartile was 2.06 (p=0.047).
Conclusions:
- Elevated admission hs-cTnI levels in NSTEMI patients indicate a higher mortality risk.
- Further prospective studies are needed to evaluate the impact of early reperfusion strategies based on admission troponin levels on NSTEMI patient mortality.
Background:
Timely reperfusion within 120 min is strongly recommended in patients presenting with non-ST-segment myocardial infarction (NSTEMI) with very high-risk features. Evidence regarding the use of high-sensitivity cardiac troponin (hs-cTn) concentration upon admission for the risk-stratification of patients presenting with NSTEMI to expedite percutaneous coronary intervention (PCI) and thus potentially improve outcomes is limited.
Methods:
All patients admitted to a tertiary care center ICCU between July 2019 and July 2022 were included. Hs-cTnI levels on presentaion were recorded, dividing patients into quartiles based on baseline hs-cTnI. Association between initial hs-cTnI and all-cause mortality during up to 3 years of follow-up was studied.
Results:
A total of 544 NSTEMI patients with a median age of 67 were included. Hs-cTnI levels in each quartile were: (a) ≤122, (b) 123-680, (c) 681-2877, and (d) ≥2878 ng/L. There was no difference between the initial hs-cTnI level groups regarding age and comorbidities. A higher mortality rate was observed in the highest hs-cTnI quartile as compared with the lowest hs-cTnI quartile (16.2% vs. 7.35%, p = .03) with hazard ratio (HR) for mortality of 2.6 (95% confidence interval [CI]: 1.23-5.4; p = .012) in the unadjusted model, and HR of 2.06 (95% CI: 1.01-4.79; p = .047) with adjustment for age, gender, serum creatinine, and significant comorbidities.
Conclusions:
Patients with NSTEMI and higher hs-cTnI levels upon admission faced elevated mortality risk. This underscores the need for further prospective investigations into early reperfusion strategies' impact on NSTEMI patients' mortality, based on admission troponin elevation.
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