Key result
In patients presenting with NSTEMI, those in the highest quartile of admission hs-cTnI (≥2878 ng/L) had a significantly increased risk of all-cause mortality compared to those in the lowest quartile (adjusted HR 2.06).
Why the study?
Evidence is limited regarding the use of admission high-sensitivity cardiac troponin concentration for risk-stratification of NSTEMI patients to expedite PCI and potentially improve outcomes.
Does an elevated initial hs-cTnI level at presentation predict higher all-cause mortality in patients with NSTEMI?
Cohort (n=544)
No
Does an elevated initial hs-cTnI level at presentation predict higher all-cause mortality in patients with NSTEMI?
Significantly elevated hs-cTnI on admission is an independent predictor of long-term all-cause mortality in NSTEMI patients, highlighting its potential value in guiding early revascularization strategies.
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.
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Loutati et al. (2023) conducted a cohort in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=544). High initial high-sensitivity cardiac troponin I (hs-cTnI) levels (≥2878 ng/L, highest quartile) vs. Low initial hs-cTnI levels (≤122 ng/L, lowest quartile) was evaluated on All-cause mortality (Adjusted HR 2.06, 95% CI 1.01-4.79, p=0.047). In patients presenting with NSTEMI, those in the highest quartile of admission hs-cTnI (≥2878 ng/L) had a significantly increased risk of all-cause mortality compared to those in the lowest quartile (adjusted HR 2.06).
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