Elevated troponin I in patients with hypertensive crisis was associated with a significantly higher 2-year rate of MACCE compared to normal troponin I (71.4% vs 38.3%; HR 2.77; 95% CI 1.79-4.27).
Cohort (n=171)
Does elevated troponin predict long-term MACCE and obstructive CAD in patients presenting with hypertensive crisis?
In patients with hypertensive crisis, elevated troponin I is a strong predictor of underlying obstructive CAD and confers a significantly greater risk of long-term MACCE.
Effect estimate: HR 2.77 (95% CI 1.79-4.27)
Absolute Event Rate: 71.4% vs 38.3%
p-value: p=<0.001
BACKGROUND: Hypertensive crisis is associated with poor clinical outcomes. Elevated troponin, frequently observed in hypertensive crisis, may be attributed to myocardial supply-demand mismatch or obstructive coronary artery disease (CAD). However, in patients presenting with hypertensive crisis and an elevated troponin, the prevalence of CAD and the long-term adverse cardiovascular outcomes are unknown. OBJECTIVE: We sought to assess the impact of elevated troponin on cardiovascular outcomes and evaluate the role of troponin as a predictor of obstructive CAD in patients with hypertensive crisis. METHODS: Patients who presented with hypertensive crisis (n = 236) were screened retrospectively. Baseline and follow-up data including the event rates were obtained using electronic patient records. Those without an assay for cardiac Troponin I (cTnI) (n = 65) were excluded. Of the remaining 171 patients, those with elevated cTnI (cTnI ≥ 0.12 ng/ml) (n = 56) were compared with those with normal cTnI (cTnI < 0.12 ng/ml) (n = 115) at 2 years for the occurrence of major adverse cardiac or cerebrovascular events (MACCE) (composite of myocardial infarction, unstable angina, hypertensive crisis, pulmonary edema, stroke or transient ischemic attack). RESULTS: At 2 years, MACCE occurred in 40 (71.4%) patients with elevated cTnI compared with 44 (38.3%) patients with normal cTnI hazard ratio: 2.77; 95% confidence interval (CI): 1.79-4.27; P < 0.001. Also, patients with elevated cTnI were significantly more likely to have underlying obstructive CAD (odds ratio: 8.97; 95% CI: 1.4-55.9; P < 0.01). CONCLUSION: In patients with hypertensive crisis, elevated cTnI confers a significantly greater risk of long-term MACCE, and is a strong predictor of obstructive CAD.
Pattanshetty et al. (Tue,) conducted a cohort in Hypertensive crisis (n=171). Elevated cardiac Troponin I (≥ 0.12 ng/ml) vs. Normal cardiac Troponin I (< 0.12 ng/ml) was evaluated on Major adverse cardiac or cerebrovascular events (MACCE) (composite of myocardial infarction, unstable angina, hypertensive crisis, pulmonary edema, stroke or transient ischemic attack) (HR 2.77, 95% CI 1.79-4.27, p=<0.001). Elevated troponin I in patients with hypertensive crisis was associated with a significantly higher 2-year rate of MACCE compared to normal troponin I (71.4% vs 38.3%; HR 2.77; 95% CI 1.79-4.27).