NSTEMI patients with admission hs-cTnI in the highest quartile had higher all-cause mortality than those in the lowest quartile (16.2% vs 7.35%; adjusted HR 2.06; 95% CI 1.01-4.79; p=0.047).
Cohort (n=544)
No
Does a higher initial hs-cTnI level predict increased all-cause mortality in patients presenting with NSTEMI?
Higher admission hs-cTnI levels in NSTEMI patients are associated with a significantly increased risk of all-cause mortality at 3 years, suggesting a potential role for early risk stratification.
Hazard Ratio: 2.06 (95% CI 1.01–4.79)
Absolute Event Rate: 16.2% vs 7.35%
p-value: p=0.047
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.
Loutati et al. (Thu,) conducted a cohort in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=544). Highest hs-cTnI quartile (≥2878 ng/L) vs. Lowest hs-cTnI quartile (≤122 ng/L) was evaluated on All-cause mortality (HR 2.06, 95% CI 1.01-4.79, p=0.047). NSTEMI patients with admission hs-cTnI in the highest quartile had higher all-cause mortality than those in the lowest quartile (16.2% vs 7.35%; adjusted HR 2.06; 95% CI 1.01-4.79; p=0.047).