Key result
Elevated hs-cTnI detects myocardial injury with ~99% sensitivity and predicts 30-day mortality.
Why the study?
Little was documented regarding how hs-cTnI performance relates to different types of myocardial injury and its impact on morbidity and mortality.
Does elevated high-sensitivity troponin I predict 30-day mortality and characterize myocardial injury types in emergency department and inpatient settings?
Observational (n=1,975)
Does elevated high-sensitivity troponin I predict 30-day mortality and characterize myocardial injury types in emergency department and inpatient settings?
Elevated hs-cTnI in emergency and inpatient settings is most frequently caused by type 2 myocardial infarction and serves as an independent predictor of 30-day mortality.
Elevated hs-cTnI rates warrant no practice change; hypothesis-generating for injury subtypes and requires prospective confirmation.
BACKGROUND: High-sensitivity troponin I, cardiac form (hs-cTnI) accelerates the assessment of acute coronary syndrome. Little has been documented about its performance, how it relates to different types of myocardial injury, and its impact on morbidity and mortality. This study sought to expand understanding of hs-cTnI by characterizing types of myocardial injury, the impact of comorbidities, and 30-day outcomes. METHODS: The study retrospectively evaluated 1,975 patients with hs-cTnI levels obtained in the emergency department or inpatient setting from June to September 2020. Troponin was considered elevated if it was higher than the 99th percentile for either sex. Charts were reviewed to determine the presence of myocardial injury. Troponin elevation was adjusted for demographics, comorbidities, and kidney dysfunction. Thirty-day mortality and readmission rates were calculated. RESULTS: Of 1,975 patients, 468 (24%) had elevated hs-cTnI, and 330 (17%) had at least 1 type of myocardial injury, type 2 myocardial infarction being the most frequent. Sensitivity and specificity using the 99th percentile as a cutoff were 99% and 92%, respectively. The average maximum hs-cTnI level was significantly higher for type 1 myocardial infarction (P < .001). Being male, Black, non-Hispanic, and a hospital inpatient were all associated with higher initial and peak hs-cTnI levels (P < .001). Elevated hs-cTnI level, age, heart disease, kidney dysfunction, and inpatient status were predictive of 30-day mortality on multivariate analysis. CONCLUSION: Elevated hs-cTnI levels in emergency department and inpatient settings occurs most commonly because of type 2 myocardial infarction. Maximum hs-cTnI level is associated with the patient's particular type of myocardial injury, certain demographics, and cardiovascular comorbidities, and it may be a predictor of 30-day outcomes.
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Kumar et al. (2023) conducted an observational in Suspected myocardial injury (n=1,975). Elevated high-sensitivity troponin I (hs-cTnI) vs. Normal hs-cTnI levels was evaluated on Myocardial injury. Elevated hs-cTnI levels were present in 24% of patients, demonstrating 99% sensitivity and 92% specificity for myocardial injury, and were predictive of 30-day mortality.
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