Key result
While severe hs-TnI increase was associated with higher unadjusted all-cause mortality (13.1% vs 1.1% for mild increase, p=0.001), multivariable analysis did not confirm it as an independent predictor of death or MACCE.
Why the study?
The prognostic value regarding the extent of hs-TnI increase was widely investigated in MI with obstructive coronary atherosclerosis, but remained to be evaluated in patients with a MINOCA working diagnosis.
Does the extent of hs-TnI increase independently predict all-cause mortality and MACCE in patients with MINOCA?
Cohort (n=337)
Yes
Does the extent of hs-TnI increase independently predict all-cause mortality and MACCE in patients with MINOCA?
In contrast to patients with obstructive coronary disease, the magnitude of high-sensitivity troponin I elevation in MINOCA is not an independent predictor of long-term mortality or MACCE.
Background and Objectives: A topic already widely investigated is the negative prognostic value regarding the extent of high sensitive troponin I (hs-TnI) increases among patients with myocardial infarction (MI) and obstructive coronary atherosclerosis compared to a group of patients with MI and non-obstructive coronary atherosclerosis (MINOCA). Thus, the aim of this study was to evaluate the prognostic value concerning the extent of hs-TnI increase on clinical outcomes among patients with a MINOCA working diagnosis. Materials and Methods: We selected 337 consecutive patients admitted to hospital with a working diagnosis of MINOCA. The patients were divided in three groups according to the extent of hs-TnI increase during hospitalization (increase ≤5-times above the limit of the upper norm, >5 and ≤20-times, and >20-times). The study endpoints included all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE; cerebral stroke and transient ischemic attacks, MI, coronary artery revascularization, either percutaneous coronary intervention or coronary artery bypass grafting and all-cause mortality). Results: During the mean follow-up period of 516.1 ± 239.8 days, using Kaplan–Meier survival curve analysis, significantly higher mortality rates were demonstrated among patients from the group with the greatest hs-TnI increase compared to the remaining groups (p = 0.01) and borderline values for MACCE (p = 0.053). Multivariable cox regression analysis did not confirm hs-TnI among factors related to increased MACCE or all-cause mortality rates. Conclusion: While a relationship between clinical outcomes and the extent of the hs-TnI increase among patients with a MINOCA working diagnosis remains, it does not seem to be not as strong as it is in patients with obstructive coronary atherosclerosis.
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Jędrychowska et al. (2020) conducted a cohort in Myocardial infarction with non-obstructive coronary arteries (MINOCA) (n=337). Severe high-sensitive troponin I (hs-TnI) increase (>20-times upper normal limit) vs. Mild (≤5-times upper normal limit) hs-TnI increase was evaluated on All-cause mortality (p=0.001). While severe hs-TnI increase was associated with higher unadjusted all-cause mortality (13.1% vs 1.1% for mild increase, p=0.001), multivariable analysis did not confirm it as an independent predictor of death or MACCE.
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