Use of troponins in clinical practice: Evidence against the use of troponins in clinical practice

Mariathas, Mark; Curzen, Nick

doi:10.1136/heartjnl-2019-315765

Cited by 4 publications

(3 citation statements)

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“…Since the introduction of high-sensitive cardiac troponin (hs-cTn) assays, troponin testing has been used in a broad spectrum of patients to detect minor myocardial injury[ 1 , 2 ]. A variety of non-cardiac clinical conditions is accompanied by “troponinemia”[ 2 , 3 ] and many reports have investigated the association between serum hs-cTn concentrations and adverse outcomes in almost every clinical setting[ 4 - 6 ].…”

Section: Introductionmentioning

confidence: 99%

Elderly patients with non-cardiac admissions and elevated high-sensitivity troponin: the prognostic value of renal function

Samara¹,

Tsiara²,

Papafaklis³

et al. 2021

WJC

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BACKGROUND High-sensitivity cardiac troponin (hs-cTn) levels are frequently elevated in elderly patients presenting to the emergency department for non-cardiac events. However, most studies on the role of elevated hs-cTn in elderly populations have investigated the prognostic value of hs-cTn in patients with a specific diagnosis or have assessed the relationship between hs-cTn and comorbidities. AIM To investigate the in-hospital prognosis of consecutive elderly patients admitted to the Internal Medicine Department with acute non-cardiac events and increased hs-cTnI levels. METHODS In this retrospective study, we selected patients who were aged ≥ 65 years and admitted to the Internal Medicine Department of our hospital between January 2019 and December 2019 for non-cardiac reasons. Eligible patients were those who had hs-cTnI concentrations ≥ 100 ng/L. We investigated the independent predictors of in-hospital mortality by multivariable logistic regression analysis. RESULTS One hundred and forty-six patients (59% female) were selected with an age range from 65 to 100 (mean ± SD: 85.4 ± 7.61) years. The median hs-cTnI value was 284.2 ng/L. For 72 (49%) patients the diagnosis of hospitalization was an infectious disease. The overall in-hospital mortality was 32% (47 patients). Individuals who died did not have higher hs-cTnI levels compared with those who were discharged alive (median: 314.8 vs 282.5 ng/L; P = 0.565). There was no difference in mortality in patients with infectious vs non-infectious disease (29% vs 35%). Multivariable analysis showed that age (OR 1.062 per 1 year increase, 95%CI: 1.000-1.127; P = 0.048) and creatinine levels (OR 2.065 per 1 mg/dL increase, 95%CI: 1.383-3.085; P < 0.001) were the only independent predictors of death. Mortality was 49% in patients with eGFR < 30 mL/min/1.73 m 2 . CONCLUSION Myocardial injury is a malignant condition in elderly patients admitted to the hospital for non-cardiac reasons. The presence of severe renal impairment is a marker of extremely high in-hospital mortality.

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Section: Introductionmentioning

confidence: 99%

Elderly patients with non-cardiac admissions and elevated high-sensitivity troponin: the prognostic value of renal function

Samara¹,

Tsiara²,

Papafaklis³

et al. 2021

WJC

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“…A point-counterpoint set of editorials in this issue of Heart debates the role of high-sensitivity cardiac troponin (hs-cTn) measurements in clinical practice 10 11. Collinson et al 10 discuss their concerns with the troponin measurements in the CHARIOT (Current Threshold for Diagnosis of ‘Abnormality’, Including Non-ST Elevation Myocardial Infarction, Using Raised Highly Sensitive Troponin Appropriate for a Hospital Population) study 12.…”

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confidence: 99%

“…They emphasise that: ‘It is important to remember that hs-cTn assays are extremely sensitive for myocardial injury, and that myocardial injury does not always (in fact most often), does not equate acute myocardial infarction (MI). The diagnosis of MI remains clinical but the diagnostic process should be circular rather than linear, as illustrated in figure 4.’ Mariathas and Curzen11 agree that troponin tests can be used to rule-out MI but caution that the manufacturer listed 99th centile level is ‘not the ‘true’ 99th centile for all comers at a hospital, despite the fact that in the vast majority there was no clinical suspicion of MI or myocardial injury.’ That conclude that given the results of the CHARIOT study, ‘we call into question whether using troponin assays outside this clinical context is of real clinical value in most cases, particularly outside the context of a history of cardiac chest pain?’…”

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confidence: 99%

Heartbeat: is cardiovascular health affected by marital status, living alone or loneliness?

Otto

2020

Heart

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