Journal Article

Troponin level at presentation as a prognostic factor among patients presenting with non‐ST‐segment elevation myocardial infarction

Perel, Nimrod, Manassra, Mohammed, Karameh, Hani, Tabi, Meir, Steinmetz, Yoed, Marmor, David, Karmi, Mohammad, Hitter, Rafael, Asher, Elad, Bruoha, Sharon, Amsalem, Itshak, Loutati, Ranel, Glikson, Michael, Shuvy, Mony, Hamayel, Kamal, Taha, Louay, Tommer Maller

2024

Overview

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. In a study of 544 NSTEMI patients (mean age: 68; 22% females), we explored hs‐cTnI levels on admission as a prognostic marker. The highest hs‐cTnI quartile showed increased mortality (16.2% vs. 7.3%). Adjusted HR for mortality was 2.06 (p = .047). Further prospective studies are essential to assess reperfusion strategies based on initial troponin levels.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc
• Subject: Acute coronary syndromes / Biomarkers / Body mass index / Cardiovascular disease / Chronic obstructive pulmonary disease / Clinical / Coronary vessels / Creatinine / Diabetes / Females / Heart attacks / Heart failure / Humans / Hypertension / Ischemia / Medical imaging / Mortality / Myocardial Infarction - etiology / Non-ST Elevated Myocardial Infarction - diagnosis / Non-ST Elevated Myocardial Infarction - therapy / NSTEMI / Percutaneous Coronary Intervention - adverse effects / Prognosis / Survival analysis / troponin / Troponin I / Troponin T