Poor outcome among patients undergoing myocardial perfusion imaging with intermediate-zone troponin
- 26 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Internal and Emergency Medicine
- Vol. 17 (3), 655-663
- https://doi.org/10.1007/s11739-021-02668-1
Abstract
Background Intermediate zone troponin elevation is defined as one to five times the upper limit of normal. Approximately half the patients presenting with chest pain to the emergency department have initial intermediate zone troponin. Objectives We aimed to investigate the long-term outcome of patients hospitalized with chest pain and intermediate zone troponin elevation. Methods We investigated 8269 patients hospitalized in a tertiary center with chest pain. All patients had serial measurements of troponin during hospitalization. Patients were divided into three groups based on their initial troponin levels: negative troponin (N = 6112), intermediate zone troponin (N = 1329) and positive troponin (N = 828). All patients underwent myocardial perfusion imaging (MPI) as part of the initial evaluation. Results Mean age of the study population was 68 ± 11, of whom 36% were women. Patients with an intermediate zone troponin were older, more likely to be males, and with significantly more cardiovascular co-morbidities. Multivariate analysis adjusted for age, gender, cardiovascular risk factors, and abnormal MPI result found that patients with intermediate zone troponin had a 70% increased risk of re-hospitalization at 1 year (HR 1.70, 95%CI 1.48–1.96, p-value < 0.001) and 5.3 times higher risk of total mortality at 1-year (HR 5.33, 95%CI 3.65–7.78, p-value < 0.001). sub-group analysis found that among the intermediate zone troponin group, patients with double intermediate zone troponin had the poorest outcome. Conclusions Intermediate zone troponin elevation is an independent risk factor associated with adverse outcomes and therefore patients with an initial value in this range should be closely monitored and aggressively managed.This publication has 21 references indexed in Scilit:
- Prognostic value of sensitive troponin T in patients with stable and unstable angina and undetectable conventional troponinAmerican Heart Journal, 2011
- Clinical significance of initial troponin I in the grey zone in emergency department chest pain patients: a retrospective pilot studyEmergency Medicine Journal, 2010
- Role of first-drawn indeterminate troponin-I levels in the Emergency DepartmentInternational Journal of Cardiology, 2009
- Use of Guidelines-Recommended Management and Outcomes Among Women and Men With Low-Level Troponin ElevationCirculation: Cardiovascular Quality and Outcomes, 2009
- The clinical need for high-sensitivity cardiac troponin assays for acute coronary syndromes and the role for serial testingAmerican Heart Journal, 2008
- A Model for Troponin I as a Quantitative Predictor of In-Hospital MortalityJournal of the American College of Cardiology, 2006
- Implication of different cardiac troponin I levels for clinical outcomes and prognosis of acute chest pain patientsJournal of the American College of Cardiology, 2004
- Impact of myocardial perfusion imaging on clinical management and the utilization of hospital resources in suspected acute coronary syndromesNuclear Medicine Communications, 2003
- Sensitivity, specificity and accuracy of stress SPECT myocardial perfusion imaging for detection of coronary artery disease in the distribution of first-order branch vessels, using an anatomical matching of angiographic and perfusion dataNuclear Medicine Communications, 2003
- Quantification of myocardial infarction during coronary occlusion and myocardial salvage after reperfusion using cardiac imaging with technetium-99m hexakis 2-methoxyisobutyl isonitrileJournal of the American College of Cardiology, 1988