Key result
Elevated hs-TnT in acute medical admissions is linked to ~40% mortality, mostly without AMI.
Why the study?
The introduction of a high sensitivity troponin T assay has created uncertainty regarding the clinical significance of abnormal troponin T levels in acute medicine.
Cohort (n=220)
Elevated high-sensitivity troponin T is common in acute medical admissions and often reflects non-cardiac pathology, which is associated with a poor long-term prognosis.
Elevated hs-TnT without MI identifies high-mortality acute admissions; leaves open targeted risk stratification and management strategies.
BACKGROUND: Troponin testing in acute medicine is routine. The introduction of a high sensitivity assay (hs Tn T) has created uncertainty regarding the clinical significance of 'abnormal' troponin T levels. The previous assay could not detect troponin levels <30 ng/l. AIMS AND METHODS: To characterize those with a hs Tn T ≥14 ng/l. Prospective cohort study of consecutive admissions to an acute medical unit. RESULTS: Troponin was measured in 564 consecutive patients (∼50% of all admissions) over 1 month; was ≥14 ng/l in 224 (40%) of which 220 patients had demographic data for this analysis. Median (inter-quartile range) peak troponin was 47.5 ng/l (24-130) and 36% had a Tn T between 14 and 30 ng/l. Mean [standard deviation (SD)] age was 72 (12) years and 57% were male. Only 44 patients (20%) had an acute myocardial infarction, reflecting the increased sensitivity but reduced specificity of the assay. Prognosis was poor with 31% mortality at 1 year. Over a mean (SD) follow-up of 648 (61) days, there were 87 deaths (40%). Those with a primary non-cardiac diagnosis (n = 126) had poorer survival than those with a primary cardiac diagnosis (n = 94). Troponin elevation related to sepsis conferred a very poor prognosis with 24 deaths (70%) over the follow-up period. CONCLUSION: Elevated hs Tn T is very common in acute medicine, but myocardial infarction as an explanation is uncommon. Overall, the prognosis is poor with a tendency to worse outcomes in those with a primary 'non-cardiac' diagnosis.
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Petrie et al. (2013) conducted a cohort in Acute medical admissions (n=220). Elevated high sensitivity troponin T (≥14 ng/l) was evaluated on Mortality. Elevated high-sensitivity troponin T (≥14 ng/l) in acute medical admissions was associated with a 40% mortality rate over a mean 648 days, with only 20% having an acute myocardial infarction.
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