Impact of comorbidities on peak troponin levels and mortality in acute myocardial infarction
Open Access
- 26 February 2020
- Vol. 106 (9), 677-685
- https://doi.org/10.1136/heartjnl-2019-315844
Abstract
ObjectivesTo characterise peak cardiac troponin levels, in patients presenting with acute myocardial infarction (AMI), according to their comorbid condition and determine the influence of peak cardiac troponin (cTn) levels on mortality.MethodsWe included patients with the first admission for AMI in the UK. We used linear regression to estimate the association between eight common comorbidities (diabetes mellitus, previous angina, peripheral arterial disease, previous myocardial infarction (MI), chronic kidney disease (CKD), cerebrovascular disease, chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD)) and peak cTn. Peak cTn levels were adjusted for age, sex, smoking status and comorbidities. Logistic regression and restricted cubic spline models were employed to investigate the association between peak cTn and 180-day mortality for each comorbidity.Results330 367 patients with ST elevation myocardial infarction and non-ST elevation myocardial infarction were identified. Adjusted peak cTn levels were significantly higher in patients with CKD (adjusted % difference in peak cTnT for CKD=42%, 95% CI 13.1 to 78.4) and significantly lower for patients with COPD, previous angina, previous MI and CHF when compared with patients without the respective comorbidities (reference group) (cTnI; COPD=−21.7%, 95% CI −29.1 to −13.4; previous angina=−24.2%, 95% CI −29.6 to −8.3; previous MI=−13.5%, 95% CI −20.6 to −5.9; CHF=−28%, 95% CI −37.2 to −17.6). Risk of 180-day mortality in most of the comorbidities did not change substantially after adjusting for peak cTn. In general, cTnI had a stronger association with mortality than cTnT.ConclusionsIn this nationwide analysis of patients presenting with AMI, comorbidities substantially influenced systemic concentrations of peak cTn. Comorbid illness is a significant predictor of mortality regardless of peak cTn levels and should be taken into consideration while interpreting cTn both as a diagnostic and prognostic biomarker.Keywords
This publication has 28 references indexed in Scilit:
- Association of chronic lung disease with treatments and outcomes patients with acute myocardial infarctionAmerican Heart Journal, 2013
- Raised troponin in COPD: clinical implications and possible mechanismsHeart, 2012
- How to use high-sensitivity cardiac troponins in acute cardiac careEuropean Heart Journal, 2012
- Usefulness of Peak Troponin-T to Predict Infarct Size and Long-Term Outcome in Patients With First Acute Myocardial Infarction After Primary Percutaneous Coronary InterventionThe American Journal of Cardiology, 2009
- Dynamic prognostication in non-ST–elevation acute coronary syndromes: insights from GUSTO-IIB and pursuitAmerican Heart Journal, 2004
- Cardiac troponins in renal insufficiency: Review and clinical implicationsJournal of the American College of Cardiology, 2002
- Chronic Obstructive Pulmonary DiseaseThe New England Journal of Medicine, 2000
- Ischemic Preconditioning in HumansCirculation, 1999
- Does arterial revascularization decrease the risk of infarction after coronary artery bypass grafting?The Annals of Thoracic Surgery, 1998
- Long-term prognosis after myocardial infarction in patients with previous coronary artery bypass surgeryJournal of the American College of Cardiology, 1988