Association between troponin level and medium-term mortality in 20 000 hospital patients
Association between troponin level and medium-term mortality in 20 000 hospital patients
Introduction Cardiac troponin (cTn) concentrations above the manufacturer recommended upper limit of normal (ULN) are frequently seen in hospital patients without a clinical presentation consistent with type 1 myocardial infarction, and the significance of this is uncertain. The aim of this study was to assess the relationship between medium-term mortality and cTn concentration in a large consecutive hospital population, regardless of whether there was a clinical indication for performing the test. Method This prospective observational study included 20 000 consecutive in-hospital and outpatient patients who had a blood test for any reason at a large teaching hospital, and in whom a hs-cTnI assay was measured, regardless of the original clinical indication. Mortality was obtained via NHS Digital. Results A total of 20 000 patients were included in the analysis and 18 282 of these (91.4%) did not have a clinical indication for cardiac troponin I (cTnI) testing. Overall, 2825 (14.1%) patients died at a median of 809 days. The mortality was significantly higher if the cTnI concentration was above the ULN (45.3% vs 12.3% p<0.001 log rank). Multivariable Cox analysis demonstrated that the log 10 cTnI concentration was independently associated with mortality (HR 1.76 (95% CI 1.65 to 1.88)). Landmark analysis, excluding deaths within 30 days, showed the relationship between cTnI concentration and mortality persisted. Conclusion In a large, unselected hospital population, in 91.4% of whom there was no clinical indication for testing, cTnI concentration was independently associated with medium-term cardiovascular and non-cardiovascular mortality in the statistical model tested.
Myocardial Infarction
1772-1777
Hinton, Jonathan
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Mariathas, Mark
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Gabara, Lavinia
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Allan, Rick
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Nicholas, Zoe
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Kwok, Chun Shing
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Ramamoorthy, Sanjay
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Calver, Alison
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Corbett, Simon
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Jabbour, Richard J.
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Mahmoudi, Michael
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Rawlins, John
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Sirohi, Rohit
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Wilkinson, J.
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Cook, Paul
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Martin, Glen P.
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Mamas, Mamas
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Curzen, Nicholas
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1 December 2023
Hinton, Jonathan
2e15a197-77ec-4f89-9b08-f632800837f0
Mariathas, Mark
a84e1b55-ce48-45cd-ae77-82d9b25cb693
Gabara, Lavinia
bbc105d9-9119-456f-9495-6b0863a8ea2f
Allan, Rick
2726ab31-1430-4275-becc-461fb4023442
Nicholas, Zoe
98403583-c418-45ad-836b-1831517dcc5f
Kwok, Chun Shing
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Ramamoorthy, Sanjay
b0d15032-4158-4661-8124-58071e8dc900
Calver, Alison
b10f84f4-e427-44e9-a349-754ca1371f25
Corbett, Simon
325a1edd-5325-4981-a5df-787d53f36d5e
Jabbour, Richard J.
9268c6b6-c7b3-48c6-b617-b50899c0eabc
Mahmoudi, Michael
c2963fd5-cb01-4e6e-97bc-df5143aa3e83
Rawlins, John
f3a7a25c-c8b2-477a-b441-ce9704a7a331
Sirohi, Rohit
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Wilkinson, J.
446a9877-a22d-4063-b234-0d2c965599fd
Cook, Paul
b8e76445-8d7e-40bf-b97f-e42678e90e57
Martin, Glen P.
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Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Curzen, Nicholas
70f3ea49-51b1-418f-8e56-8210aef1abf4
Hinton, Jonathan, Mariathas, Mark, Gabara, Lavinia, Allan, Rick, Nicholas, Zoe, Kwok, Chun Shing, Ramamoorthy, Sanjay, Calver, Alison, Corbett, Simon, Jabbour, Richard J., Mahmoudi, Michael, Rawlins, John, Sirohi, Rohit, Wilkinson, J., Cook, Paul, Martin, Glen P., Mamas, Mamas and Curzen, Nicholas
(2023)
Association between troponin level and medium-term mortality in 20 000 hospital patients.
Heart, 109 (23), , [heartjnl-2023-322463].
(doi:10.1136/heartjnl-2023-322463).
Abstract
Introduction Cardiac troponin (cTn) concentrations above the manufacturer recommended upper limit of normal (ULN) are frequently seen in hospital patients without a clinical presentation consistent with type 1 myocardial infarction, and the significance of this is uncertain. The aim of this study was to assess the relationship between medium-term mortality and cTn concentration in a large consecutive hospital population, regardless of whether there was a clinical indication for performing the test. Method This prospective observational study included 20 000 consecutive in-hospital and outpatient patients who had a blood test for any reason at a large teaching hospital, and in whom a hs-cTnI assay was measured, regardless of the original clinical indication. Mortality was obtained via NHS Digital. Results A total of 20 000 patients were included in the analysis and 18 282 of these (91.4%) did not have a clinical indication for cardiac troponin I (cTnI) testing. Overall, 2825 (14.1%) patients died at a median of 809 days. The mortality was significantly higher if the cTnI concentration was above the ULN (45.3% vs 12.3% p<0.001 log rank). Multivariable Cox analysis demonstrated that the log 10 cTnI concentration was independently associated with mortality (HR 1.76 (95% CI 1.65 to 1.88)). Landmark analysis, excluding deaths within 30 days, showed the relationship between cTnI concentration and mortality persisted. Conclusion In a large, unselected hospital population, in 91.4% of whom there was no clinical indication for testing, cTnI concentration was independently associated with medium-term cardiovascular and non-cardiovascular mortality in the statistical model tested.
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Accepted/In Press date: 20 July 2023
e-pub ahead of print date: 7 August 2023
Published date: 1 December 2023
Additional Information:
Funding Information:
Unrestricted Research Grant from Beckman Coulter (BC) for the high sensitivity troponin assays.
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© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords:
Myocardial Infarction
Identifiers
Local EPrints ID: 478803
URI: http://eprints.soton.ac.uk/id/eprint/478803
ISSN: 1355-6037
PURE UUID: 195bf22c-d95f-4b15-9b35-002bf60c48b0
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Date deposited: 10 Jul 2023 16:52
Last modified: 18 Mar 2024 03:01
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Contributors
Author:
Jonathan Hinton
Author:
Mark Mariathas
Author:
Lavinia Gabara
Author:
Rick Allan
Author:
Zoe Nicholas
Author:
Chun Shing Kwok
Author:
Sanjay Ramamoorthy
Author:
Alison Calver
Author:
Simon Corbett
Author:
Richard J. Jabbour
Author:
Michael Mahmoudi
Author:
John Rawlins
Author:
Rohit Sirohi
Author:
J. Wilkinson
Author:
Paul Cook
Author:
Glen P. Martin
Author:
Mamas Mamas
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