Characterization of Myocardial Injury With High-Sensitivity Troponin
Sant Kumar1, Nayrana Griffith1, Dylan Walter1
1Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC.
Insights
High-sensitivity troponin I (hs-cTnI) elevation often indicates type 2 myocardial infarction. hs-cTnI levels predict 30-day mortality, influenced by injury type, demographics, and comorbidities.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Diagnostics
Background:
- High-sensitivity troponin I (hs-cTnI) aids acute coronary syndrome assessment.
- Limited data exists on hs-cTnI performance across myocardial injury types and its prognostic value.
- This study investigates hs-cTnI in various myocardial injury contexts and 30-day outcomes.
Purpose of the Study:
- To characterize myocardial injury types associated with elevated hs-cTnI.
- To analyze the impact of demographics and comorbidities on hs-cTnI levels.
- To evaluate hs-cTnI as a predictor of 30-day morbidity and mortality.
Main Methods:
- Retrospective analysis of 1,975 patients with hs-cTnI measurements.
- Defined elevated troponin using the 99th percentile cutoff.
- Reviewed charts for myocardial injury, comorbidities, and kidney dysfunction.
- Calculated 30-day mortality and readmission rates.
Main Results:
- 24% of patients had elevated hs-cTnI; 17% had myocardial injury, most commonly type 2 myocardial infarction.
- hs-cTnI sensitivity and specificity were 99% and 92%, respectively.
- Higher hs-cTnI levels correlated with type 1 myocardial infarction, male sex, Black race, non-Hispanic ethnicity, and inpatient status.
- Elevated hs-cTnI, age, heart disease, kidney dysfunction, and inpatient status predicted 30-day mortality.
Conclusions:
- Elevated hs-cTnI in ED/inpatient settings frequently results from type 2 myocardial infarction.
- Maximum hs-cTnI levels correlate with injury type, demographics, and comorbidities.
- hs-cTnI may serve as a predictor of short-term outcomes.
Background:
High-sensitivity troponin I, cardiac form (hs-cTnI) accelerates the assessment of acute coronary syndrome. Little has been documented about its performance, how it relates to different types of myocardial injury, and its impact on morbidity and mortality. This study sought to expand understanding of hs-cTnI by characterizing types of myocardial injury, the impact of comorbidities, and 30-day outcomes.
Methods:
The study retrospectively evaluated 1,975 patients with hs-cTnI levels obtained in the emergency department or inpatient setting from June to September 2020. Troponin was considered elevated if it was higher than the 99th percentile for either sex. Charts were reviewed to determine the presence of myocardial injury. Troponin elevation was adjusted for demographics, comorbidities, and kidney dysfunction. Thirty-day mortality and readmission rates were calculated.
Results:
Of 1,975 patients, 468 (24%) had elevated hs-cTnI, and 330 (17%) had at least 1 type of myocardial injury, type 2 myocardial infarction being the most frequent. Sensitivity and specificity using the 99th percentile as a cutoff were 99% and 92%, respectively. The average maximum hs-cTnI level was significantly higher for type 1 myocardial infarction (P < .001). Being male, Black, non-Hispanic, and a hospital inpatient were all associated with higher initial and peak hs-cTnI levels (P < .001). Elevated hs-cTnI level, age, heart disease, kidney dysfunction, and inpatient status were predictive of 30-day mortality on multivariate analysis.
Conclusion:
Elevated hs-cTnI levels in emergency department and inpatient settings occurs most commonly because of type 2 myocardial infarction. Maximum hs-cTnI level is associated with the patient's particular type of myocardial injury, certain demographics, and cardiovascular comorbidities, and it may be a predictor of 30-day outcomes.
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