Association between peak troponin level and prognosis among patients admitted to intensive cardiovascular care unit
Ranel Loutati1, Sharon Bruoha2, Louay Taha1
1Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
Insights
High peak levels of high-sensitivity cardiac troponin (hs-cTn) indicate significant myocardial injury and are linked to increased mortality in intensive cardiovascular care units. Prognostic value differs between STEMI and NSTEMI patients.
Area of Science:
- Cardiology
- Biomarker Research
- Intensive Care Medicine
Background:
- High-sensitivity cardiac troponin (hs-cTn) is crucial for detecting myocardial injury.
- Prognostic implications of hs-cTn in intensive cardiovascular care units (ICCU) require further elucidation.
- This study investigates the association between peak hs-cTn levels and patient outcomes in an ICCU setting.
Purpose of the Study:
- To assess the prognostic value of peak high-sensitivity cardiac troponin I (hs-cTnI) levels.
- To determine the association between hs-cTnI levels and one-year all-cause mortality in ICCU patients.
- To explore differences in mortality risk based on hs-cTnI levels across myocardial infarction subtypes.
Main Methods:
- Prospective enrollment of 4149 patients in a tertiary care ICCU (July 2019 - July 2023).
- Categorization into five groups based on peak hs-cTnI levels (ranging from <100 ng/L to ≥100,000 ng/L).
- One-year all-cause mortality as the primary outcome, analyzed using adjusted Cox models.
Main Results:
- Patients with peak hs-cTnI ≥100,000 ng/L showed a 56% increased likelihood of one-year mortality compared to the lowest group.
- Peak hs-cTnI levels ≥100,000 ng/L were highly specific for myocardial infarction (97.4%), particularly STEMI (87.5%).
- Elevated hs-cTnI was associated with higher mortality in NSTEMI patients (HR 7.62) but not in STEMI patients (HR 1.04).
Conclusions:
- Peak hs-cTnI levels ≥100,000 ng/L are a significant predictor of increased one-year mortality in ICCU patients.
- These high levels often signify large myocardial infarctions.
- The differential prognostic impact of hs-cTnI in STEMI versus NSTEMI warrants further investigation.
Introduction:
High-sensitivity cardiac troponin (hs-cTn) is a key biomarker for myocardial injury, yet its prognostic value in intensive cardiovascular care units (ICCU) remains poorly understood. We aimed to assess the association between peak hs-cTn levels and prognosis in ICCU patients.
Methods:
All patients admitted to a tertiary care center ICCU between July 2019 - July 2023 were prospectively enrolled. Patients were divided into five groups according to their peak hs-cTnI levels: A) hs-cTnI <100 ng/L; B) hs-cTnI of 100-1000 ng/L; C) hs-cTnI of 1000-10,000 ng/L; D) hs-cTnI of 10,000-100,000 ng/L and E) hs-cTnI ≥100,000 ng/L. The primary outcome was all-cause mortality at one year.
Results:
A total of 4149 patients (1273 females [30.7 %]) with a median age of 69 (IQR 58-79) were included. Group E was highly specific for myocardial infarction (97.4 %) and especially for ST segment elevation myocardial infarction (STEMI) (87.5 %). Patients in group E were 56 % more likely to die at 1-year in an adjusted Cox model (95 % CI 1.09-2.23, p = 0.014) as compared with group A. Subgroup analyses revealed that among STEMI patients, higher peak hs-cTnI levels were not associated with higher mortality rate (HR 1.04, 95 % CI 0.4-2.72, p = 0.9), in contrast to patients with NSTEMI (HR 7.62, 95 % CI 1.97-29.6, p = 0.003).
Conclusions:
Peak hs-cTnI levels ≥100,000 ng/L were linked to higher one-year mortality, largely indicative of large myocardial infarctions. Notably, the association between elevated hs-cTnI levels and mortality differed between STEMI and NSTEMI patients, warranting further investigation.
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