The Diagnostic Yield of Cardiac Catheterization in Low-Risk Troponinemia

Stripe, Benjamin; Rechenmacher, Stephen; Jurewitz, Daniel; Lee, Cody; Schaefer, Saul

doi:10.1001/jamainternmed.2013.11109

Cited by 7 publications

(6 citation statements)

References 5 publications

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“…The portion of patients evidencing high-grade coronary stenosis and undergoing revascularization accounted for 38.6%. Comparison to the data obtained by Stripe et al 26 in a non-AECOPD cohort with mild troponin elevation (11% and 8.6% of patients had IHD and underwent revascularization, respectively) implies that troponinemia in AECOPD, when compared with troponinemia in a non-AECOPD setting, is a stronger indicator for coronary processes. Data comparison based upon the patient’s history of IHD revealed no statistically significant intercohortal difference in the need for revascularization: 8/15 patients (53.3%) with and 26/73 patients (35.6%) without a prior history of IHD, respectively, received coronary intervention ( P =0.20).…”

Section: Discussionmentioning

confidence: 54%

Invasive coronary angiography in patients with acute exacerbated COPD and elevated plasma troponin

Pizarro

Herweg-Steffens

Buchenroth

et al. 2016

COPD

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BackgroundIn acute exacerbation of COPD, increased plasma levels of cardiac troponin are frequent and associated with increased mortality. Thus, we aimed at prospectively determining the diagnostic value of coronary angiography in patients with exacerbated COPD and concomitantly elevated cardiac troponin.Patients and methodsA total of 88 patients (mean age 72.9±9.2 years, 56.8% male) hospitalized for acute exacerbation of COPD with elevated plasma troponin were included. All patients underwent coronary angiography within 72 hours after hospitalization. Complementary 12-lead electrocardiogram, transthoracic echocardiography, pulmonary function, and angiological testing were performed.ResultsCoronary angiography objectified the presence of ischemic heart disease (IHD) in 59 patients (67.0%), of whom 34 patients (38.6% of total study population) underwent percutaneous coronary intervention. Among these 34 intervened patients, the vast majority (n=26, 76.5%) had no previously known IHD, whereas only eight out of 34 patients (23.5%) presented an IHD history. Patients requiring coronary intervention showed significantly reduced left ventricular ejection fraction (45.8%±13.1% vs 55.1%±13.3%, P=0.01) and a significantly more frequent electrocardiographic ST-segment depression (20.6% vs 7.4%, P=0.01). Neither additional laboratory parameters for inflammation and myocardial injury nor lung functional measurements differed significantly between the groups.ConclusionAngiographically confirmed IHD that required revascularization occurred in 38.6% of exacerbated COPD patients with elevated cardiac troponin. In this considerable portion of patients, coronary angiography emerged to be of diagnostic and therapeutic value.

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Section: Discussionmentioning

confidence: 54%

Invasive coronary angiography in patients with acute exacerbated COPD and elevated plasma troponin

Pizarro

Herweg-Steffens

Buchenroth

et al. 2016

COPD

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“…5 Troponinaemia, classically considered as an unimportant alteration once an acute coronary disease has been ruled out, requires patient's follow-up and study to find the causes that generate myocardial suffering. 6,7 For instance, values of cTnT greater than 30 ng/L may indicate demand ischaemia in the context of other serious pathologies (eg heart failure, pulmonary embolism, major trauma, kidney failure, sepsis, shock, ischaemic stroke). 8,9 In the prehospital care context, values of cTnT ≥50 ng/L correlate with a worse prognosis, regardless of the final diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Prehospital troponin as a predictor of early clinical deterioration

Martin-Rodríguez

Sanz-García

Castro-Portillo

et al. 2021

Eur J Clin Investigation

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Background and Objectives Elevated troponin T (cTnT) values are associated with comorbidities and early mortality, in both cardiovascular and noncardiovascular diseases. The objective of this study is to evaluate the prognostic accuracy of the sole utilization of prehospital point‐of‐care cardiac troponin T to identify the risk of early in‐hospital deterioration, including mortality within 28 days. Methods We conducted a prospective, multicentric, controlled, ambulance‐based, observational study in adults with acute diseases transferred with high priority by ambulance to emergency departments, between 1 January and 30 September 2020. Patients with hospital diagnosis of acute coronary syndrome were excluded. The discriminative power of the predictive cTnT was assessed through a discrimination model trained using a derivation cohort and evaluated by the area under the curve of the receiver operating characteristic on a validation cohort. Results A total of 848 patients were included in our study. The median age was 68 years (25th‐75th percentiles: 50‐81 years), and 385 (45.4%) were women. The mortality rate within 28 days was 12.4% (156 cases). The predictive ability of cTnT to predict mortality presented an area under the curve of 0.903 (95% CI: 0.85‐0.954; P < .001). Risk stratification was performed, resulting in three categories with the following optimal cTnT cut‐off points: high risk greater than or equal to 100, intermediate risk 40‐100 and low risk less than 40 ng/L. In the high‐risk group, the mortality rate was 61.7%, and on the contrary, the low‐risk group presented a mortality of 2.3%. Conclusions The implementation of a routine determination of cTnT on the ambulance in patients transferred with high priority to the emergency department can help to stratify the risk of these patients and to detect unknown early clinical deterioration.

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“…36 - 38 An analysis of myocardial injury of emergency department patients showed that a fluid overload/heart failure scenario was the most common etiology. 39 Fluid overload is extremely common postoperatively, and preoperative left ventricular diastolic dysfunction has been strongly associated with postoperative myocardial injury. 40 Recent investigations using blood samples from the VISION 32 and METS 25 cohorts suggest myocardial injury has an inflammatory etiology.…”

Section: Asymptomatic Pulmonary Embolism Is Common and Ismentioning

confidence: 99%

“…36 -38 Une analyse des lésions myocardiques des patients du département des urgences a montré qu'un scénario de surcharge liquidienne/ d'insuffisance cardiaque était l'étiologie la plus fréquente. 39 La surcharge liquidienne est extrêmement fréquente en période postopératoire, et la dysfonction diastolique ventriculaire gauche préopératoire a montré une association forte avec les lésions myocardiques postopératoires. 40 Des recherches récentes utilisant des échantillons de sang des cohortes des études VISION 32 et METS 25 suggèrent que la lésion myocardique aurait une étiologie inflammatoire.…”

Section: Valeur Pronostique Des Lésions Myocardiques Postopératoiresunclassified

The emergence of a postoperative myocardial injury epidemic: true or false?

Beattie

2021

Can J Anesth/J Can Anesth

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The Diagnostic Yield of Cardiac Catheterization in Low-Risk Troponinemia

Cited by 7 publications

References 5 publications

Invasive coronary angiography in patients with acute exacerbated COPD and elevated plasma troponin

Invasive coronary angiography in patients with acute exacerbated COPD and elevated plasma troponin

Prehospital troponin as a predictor of early clinical deterioration

The emergence of a postoperative myocardial injury epidemic: true or false?

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