Key result
Non-ischaemic myocardial injury in the ED linked to ~75% higher all-cause mortality.
Why the study?
Non-ischaemic myocardial injury accounts for most cardiac troponin elevations in the emergency department, but its clinical management and long-term prognostic implications remain uncertain.
Does non-ischaemic myocardial injury increase the risk of long-term all-cause mortality and major adverse cardiovascular events in emergency department patients undergoing systematic cardiac troponin testing?
Cohort (n=2,715)
Does non-ischaemic myocardial injury increase the risk of long-term all-cause mortality and major adverse cardiovascular events in emergency department patients undergoing systematic cardiac troponin testing?
Incidental detection of non-ischaemic myocardial injury in the emergency department independently predicts a substantially poorer 5-year prognosis, driven predominantly by increased all-cause mortality and major adverse cardiovascular events.
Non-ischaemic myocardial injury signals higher long-term mortality in ED patients; extends prognostic observations but remains hypothesis-generating without prospective validation.
Background/Objectives: Cardiac troponin measurement in the emergency department frequently detects non-ischaemic myocardial injury. Although this condition accounts for most troponin elevations, its clinical management remains uncertain. This study aims to determine its prevalence and evaluate its prognostic implications at a 5-year follow-up. Methods: We conducted a retrospective cohort study of 2715 emergency department patients undergoing systematic cardiac troponin testing, excluding type 1 or 2 acute myocardial infarctions. Patients with non-ischaemic myocardial injury (n = 254, 9.4%) were compared to controls (n = 2461, 90.6%) using propensity score methods (overlap weighting and 1:1 matching). Results: Before matching, patients with non-ischaemic injury were older with higher comorbidities. After overlap weighting, the risks of all-cause mortality (hazard ratio [HR] 1.75, 95% CI 1.45–2.11; p < 0.001) and major adverse cardiovascular events (HR 1.78, 95% CI 1.49–2.13; p < 0.001) remained significantly higher in the non-ischaemic injury group over a median 5.07-year follow-up. In cause-specific Cox analysis, heart failure readmission rate was increased among survivors (HR 1.64, 95% CI 1.16–2.30; p = 0.005); however, when accounting for all-cause mortality as a competing risk, this association attenuated (subdistribution hazard ratio [sHR] 1.27, 95% CI 0.90–1.80; p = 0.168). Recurrent myocardial infarction readmissions did not differ between groups (cause-specific HR 1.61, 95% CI 0.70–3.72; p = 0.265; Fine–Gray sHR 1.26, 95% CI 0.55–2.91; p = 0.596). Conclusions: Incidental detection of non-ischaemic myocardial injury in the emergency department independently predicts a substantially poorer long-term prognosis, predominantly driven by all-cause mortality. These findings highlight the clinical importance of recognizing non-ischaemic injury as a marker of high vulnerability requiring close long-term clinical follow-up.
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Jurado-Meléndez et al. (2026) conducted a cohort in Non-ischaemic myocardial injury in emergency department patients (n=2,715). Non-ischaemic myocardial injury vs. Controls without non-ischaemic myocardial injury was evaluated on All-cause mortality (HR 1.75, 95% CI 1.45-2.11, p=<0.001). Non-ischaemic myocardial injury in the emergency department was associated with higher all-cause mortality (HR 1.75; 95% CI 1.45-2.11; p<0.001) and MACE (HR 1.78; 95% CI 1.49-2.13).
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