Incidentally Raised Cardiac Troponin I Has a Worse Prognosis in Older Patients Compared to Those with Normal Cardiac Troponin I and Patients with Acute Coronary Syndrome: A Cohort Study

Abstract

Background: Incidentally elevated cardiac troponin I (cTnI) levels are common in acutely unwell older patients. However, little is known about how this impacts on the prognosis of these patients. Objective: We aimed to investigate whether incidentally elevated cTnI levels (group 1) are associated with poorer outcome when compared to age- and sex-matched patients without an elevated cTnI level (group 2), and to patients diagnosed with acute coronary syndrome (group 3). Patients and Methods: This prospective, matched cohort study placed patients ≥75 years old who were admitted to a University teaching hospital into groups 1-3, based on the cTnI levels and underlying diagnosis. Outcomes were compared between the groups using mixed-effects regression models and adjusted for renal function and C-reactive protein. All-cause mortality at discharge, at 1 month and 3 months, alongside the length of hospital stay (LOS), were recorded. Results: In total, 315 patients were included, with 105 patients in each of the 3 groups. The mean age was 84.8 ± 5.5 years, with 41.9% males. All patients were followed up for 3 months. The percent all-cause mortality at discharge and the LOS for groups 1, 2 and 3 were 12.4, 3.8 and 8.6% and 11.2, 8.5 and 7.7 days, respectively. Group 1 had significantly increased mortality at 3 months [odds ratio (OR) 2.80, 95% confidence interval (CI) 1.12-6.96; p = 0.040] and LOS (OR 1.39, 95% CI 1.08-1.79; p = 0.008) compared to group 2 and did not differ significantly when compared to 3-month mortality (OR 2.39, 95% CI 0.91-6.29; p = 0.079) or LOS (OR 1.26, 95% CI 0.96-1.66; p = 0.097) in group 3. Conclusion: There is a significant association between an incidental rise in cTnI level with mortality and LOS in older patients. Further research is required to evaluate whether a more systematic management of these patients would improve the prognosis.

Troponin T Elevation After Percutaneous Left Atrial Appendage Occlusion

“…cTNT elevation has been associated with poor prognosis in many conditions (26,27). However, the mild and transient elevation of cTNT in our study did not contribute to the poor prognosis, indicating that the increase in cTNT is mostly transient myocardial injury caused by occluder implantation, which does not affect cardiac ejection function and ventricular survival area.…”

Accounting for frailty and multimorbidity when interpreting high‐sensitivity troponin I tests in oldest old

“…Frailty was also an independent predictor of pooled 3‐month mortality in our dataset (Table 4), unlike hs‐TnI elevation, which was not associated with substantial outcome prediction capacity. Previous studies have instead shown a significant association between hs‐TnI levels and adverse outcomes in older subjects, both in community and ED setting 44–47 . The reason of this discrepancy may partly depend on the short follow‐up period considered in our study, which should be regarded as one of its main limitations.…”

“…Previous studies have instead shown a significant association between hs‐TnI levels and adverse outcomes in older subjects, both in community and ED setting. 44 , 45 , 46 , 47 The reason of this discrepancy may partly depend on the short follow‐up period considered in our study, which should be regarded as one of its main limitations. However, the CFS represents a strong predictor of mortality in many settings, especially in acute conditions.…”