Associations between cardiac troponin, mortality and subsequent use of cardiovascular services: differences in sex and ethnicity

Abstract

BackgroundThe impact of cardiac troponin (cTn) testing on the downstream use of cardiovascular services is not well understood. We conducted this large-scale single centre cohort study to investigate the patterns of testing that result from the use of cTn.MethodsWe conducted this investigation using data collected between 1 January 2013 and 18 December 2015 from an academically affiliated tertiary care centre. Data from all hospitalised patients evaluated with cTn (Roche Elecsys cTn-T) assay were collected from our integrated data repository and divided into two cohorts: all cTn assays negative (<0.03 µg/L) versus at least one elevated (≥0.03 µg/L). The main outcomes were the frequency of use cardiovascular services and mortality.ResultsAmong 26 663 subjects, 18.6% had at least one elevated cTn assay; acute myocardial infarction was diagnosed in 3.9% overall. More men received cardiac catheterisation and cardiology consultation (OR 1.29, 95% CI 1.20 to 1.39 and OR 1.45, 95% CI 1.31 to 1.61) while African-American patients were less likely to have either catheterisation (OR 0.85, 95% CI 0.77 to 0.93) or consultation (OR 0.72, 95% CI 0.63 to 0.82) performed. Mortality was associated with detectable cTn (HR 2.05, P<0.0001).ConclusionsAmong hospitalised patients evaluated with cTn, we observed patterns of underuse and overuse of cardiovascular services. These patterns may have further relevance when high-sensitivity cTn assays are available in the USA. Sex and race-based disparities in cardiovascular services persist.

Association of troponin level and age with mortality in 250 000 patients: cohort study across five UK acute care centres

“…Most of the mortality increment occurred within the first six months (fig 3). This pattern of early excess mortality in patients admitted to hospital with a raised troponin level was also seen in a US study of 25 000 hospital patients 19…”

Myocardial infarction classification and its implications on measures of cardiovascular outcomes, quality, and racial/ethnic disparities

“…Disparities in cTn could also have an impact with respect to cardiovascular‐related services. While the current definition of MI encourages judicious use of cTn in testing, misdiagnoses could potentially increase the amount of resources needed to correctly diagnose the MI leading to nontrivial risks costs 6 . Thus, we recently hypothesized that patients with elevated cTn would undergo more testing than those without elevated cTn.…”

Inpatient Mortality and 30-Day Readmission Rates Associated with Troponin Testing in Patients without Acute Myocardial Infarction

“…Overall, these data appear consistent with recent reports from other larger observational studies from similar cohorts with regard to risk factors such as age, elevated creatinine, any smoking history, hypertension, diabetes, and/or hyperlipidemia. 8,9 For this analysis, we included all inpatient admissions with troponin testing, since patient demographics are known to influence readmission. Not surprisingly, we found patients with more comorbidities carry a higher rate of TnI testing, higher rate of positive TnI results, increased inpatient mortality, and higher 30-day readmission rates.…”