Article Text
PDF
Abstract
Introduction Cardiac troponin (cTn) concentrations above the manufacturer recommended upper limit of normal (ULN) are frequently seen in hospital patients without a clinical presentation consistent with type 1 myocardial infarction, and the significance of this is uncertain. The aim of this study was to assess the relationship between medium-term mortality and cTn concentration in a large consecutive hospital population, regardless of whether there was a clinical indication for performing the test.
Method This prospective observational study included 20 000 consecutive in-hospital and outpatient patients who had a blood test for any reason at a large teaching hospital, and in whom a hs-cTnI assay was measured, regardless of the original clinical indication. Mortality was obtained via NHS Digital.
Results A total of 20 000 patients were included in the analysis and 18 282 of these (91.4%) did not have a clinical indication for cardiac troponin I (cTnI) testing. Overall, 2825 (14.1%) patients died at a median of 809 days. The mortality was significantly higher if the cTnI concentration was above the ULN (45.3% vs 12.3% p<0.001 log rank). Multivariable Cox analysis demonstrated that the log10 cTnI concentration was independently associated with mortality (HR 1.76 (95% CI 1.65 to 1.88)). Landmark analysis, excluding deaths within 30 days, showed the relationship between cTnI concentration and mortality persisted.
Conclusion In a large, unselected hospital population, in 91.4% of whom there was no clinical indication for testing, cTnI concentration was independently associated with medium-term cardiovascular and non-cardiovascular mortality in the statistical model tested.
- Myocardial Infarction
Data availability statement
No data are available. The nature of the data sharing agreement with NHS Digital prevents sharing of these data.
Statistics from Altmetric.com
Data availability statement
No data are available. The nature of the data sharing agreement with NHS Digital prevents sharing of these data.
Footnotes
Twitter @DrShingKwok, @MMamas1973, @ncurzen
Contributors JH: Conceptualisation, data curation, formal analysis, investigation, methodology, project administration, resources, software, validation, visualisation, writing—original draft. MNM: Conceptualisation, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, visualisation, writing—review and editing. LG: Investigation, methodology, project administration, visualisation, writing—review and editing. ZN: Conceptualisation, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, visualisation, writing—review and editing. CSK: Formal analysis, investigation, methodology, visualisation, writing—review and editing; SR: Investigation, methodology, visualisation, writing—review and editing. AC: Conceptualisation, investigation, methodology, visualisation, writing—review and editing. SC: Conceptualisation, investigation, methodology, visualisation, writing - review and editing. RJJ: Investigation, visualisation, writing—review and editing. MM: Conceptualisation, investigation, methodology, project administration, visualisation, writing—review and editing. JR: Conceptualisation, investigation, methodology, visualisation, writing—review and editing. RS: Conceptualisation, investigation, methodology, visualisation, writing—review and editing. JW: Conceptualisation, investigation, methodology, visualisation, writing—review and editing. PC: Conceptualisation, funding acquisition, investigation, methodology, project administration, writing—review and editing. GPM: Investigation, methodology, visualisation, writing—review and editing. MAM: Formal analysis, investigation, methodology, visualisation, writing—review and editing. NC: Conceptualisation, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, software, supervision, validation, visualisation, writing—original draft, guarantor.
Funding Unrestricted Research Grant from Beckman Coulter (BC) for the high sensitivity troponin assays.
Competing interests NC: Unrestricted research grants from: Boston Scientific; Heartflow; Beckman Coulter. Speaker fees/consultancy from: Abbot Vascular; Heartflow; Boston Scientific; Travel sponsorship: Edwards; Biosensors, Abbot, Lilly/D-S; St Jude Medical, Medtronic. MM and MAM are on the editorial board of Heart.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.