Cardiovascular outcome in hospitalized patients with minimal troponin I elevation and normal creatine phosphokinase

Srivathsan, Komandoor; Showalter, John; Wilkens, James A.; Hurley, Brian W.; Abbas, Amr E.; Loutfi, Hassan

doi:10.1016/j.ijcard.2003.08.018

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…1,5,19 Increases in short-and long-term mortality have been seen in critically ill patients admitted to the intensive care unit. 31 Highly sensitive troponin assays were recently investigated in the ED setting and are associated with mortality in patients with suspected ischemic chest pain.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Postprocedure troponin positivity has been associated with worse outcomes following percutaneous coronary intervention 14 and both cardiac 15,16 and noncardiac surgery. Although the association of troponin positivity and worse outcomes in patients admitted to hospital is well established, [17][18][19] it is unclear whether this association extends to patients judged to be suitable for discharge from the emergency department (ED). Understanding how troponin positivity affects patient outcomes independently of other clinical variables is imperative when determining appropriate patient disposition and subsequent follow-up.…”

Section: Ré Sumémentioning

confidence: 99%

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Outcomes of non–acute coronary syndrome patients discharged from the emergency department with troponin positivity

Brunner

Scheuermeyer

Grafstein

et al. 2014

CJEM

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Background: Cardiac troponin elevation portends a worse prognosis in diverse patient populations. The significance of troponin elevation in patients discharged from emergency departments (EDs) without inpatient admission is not well known. Methods: Patients without a diagnosis of acute coronary syndrome discharged from two EDs between April 1, 2006, and December 31, 2007, with an abnormal cardiac troponin (troponin positive [TP]) were compared to a troponin-negative (TN) cohort matched for age, sex, and primary discharge diagnosis. Outcomes were obtained by linking with a regional ED and a provincial vital statistics database and adjusted for the following: estimated glomerular filtration rate, do-notresuscitate status, history of coronary artery disease, Canadian Triage and Acuity Scale, and left ventricular hypertrophy on electrocardiography. The primary outcome was a composite of death or admission to hospital within 1 year. Results: Our total cohort (n 5 344) consisted of 172 TP and 172 TN patients. In the univariate analysis, TP patients had a higher rate of the primary outcome (OR 3.2, 95% CI 2.1-5.0, p , 0.001) and both of its components (p , 0.001). After adjusting for covariates, positive troponin remained an independent predictor of the primary outcome (OR 2.1, 95% CI 1.3-3.4, p 5 0.005) and inpatient admission (OR 2.0, 95% CI 1.2-3.4, p 5 0.006). There was no significant difference in death (OR 1.3, 95% CI 0.6-2.9, p 5 0.5) after adjustment. Conclusions: A positive troponin assay during ED stay in discharged patients is an independent marker for risk of subsequent admission. Our findings suggest that the prognostic power of an abnormal troponin extends to patients discharged from the ED.

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Section: Discussionmentioning

confidence: 99%

Section: Ré Sumémentioning

confidence: 99%

Outcomes of non–acute coronary syndrome patients discharged from the emergency department with troponin positivity

Brunner

Scheuermeyer

Grafstein

et al. 2014

CJEM

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show abstract

“…Moreover, troponin elevation of any etiology is associated with increased risk for adverse outcomes. A small study from the Mayo Clinic (Rochester, MN) of patients with elevated troponin levels but non-cardiac diagnoses found a rate of the combined endpoint of death, MI, revascularization, or new-onset heart failure of 36% [16]. Similarly, a TACTICS-TIMI substudy found that among patients with ACS who had no significant CAD at coronary angiography, 3% of patients with troponin elevation died by 6 months versus no deaths in those with normal troponin (P < 0.001) [17].…”

Section: New Developments With Cardiac Troponinsmentioning

confidence: 99%

Current status of risk stratification methods in acute coronary syndromes

See¹,

Lemos

2006

Curr Cardiol Rep

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Distinguishing which patients with chest pain are at high risk versus which are at low risk remains an important clinical problem despite modern risk stratification strategies. Current approaches often over-utilize hospital resources, yet still miss a significant number of true acute coronary syndromes (ACS). This review focuses on important developments in risk stratification in ACS from 2004 through 2005. Risk models have been developed that use readily available patient characteristics, and head to head comparisons of the various models have been performed to guide clinicians in selecting between the different options. The most powerful models now include measurement of renal function, which has emerged as an important marker of risk. In addition to cardiac troponins, B-type natriuretic peptide (BNP) clearly augments risk prediction, and in the past year serial BNP measurement after discharge has shown promise as a simple way to monitor patient risk following ACS. Newer biomarkers are on the horizon but have not yet established their clinical value. Finally, advances in coronary CT angiography and bedside echocardiography offer hope that noninvasive imaging may play a more important role in early risk stratification in the near future.

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Emergent diagnosis of acute coronary syndromes: Today's challenges and tomorrow's possibilities

Body

2008

Resuscitation

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Cardiovascular outcome in hospitalized patients with minimal troponin I elevation and normal creatine phosphokinase

Cited by 3 publications

References 24 publications

Outcomes of non–acute coronary syndrome patients discharged from the emergency department with troponin positivity

Outcomes of non–acute coronary syndrome patients discharged from the emergency department with troponin positivity

Current status of risk stratification methods in acute coronary syndromes

Emergent diagnosis of acute coronary syndromes: Today's challenges and tomorrow's possibilities

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