Association between troponin level and medium-term mortality in 20 000 hospital patients.

Hinton, Jonathan; Mariathas, Mark Nihal; 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, James Richard; Cook, Paul; Martin, Glen Philip; Mamas, Mamas A; Curzen, Nick

Abstract

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. 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. 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 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. 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. [Abstract copyright: © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.]

Citation

Hinton, J., Mariathas, M. N., Gabara, L., Allan, R., Nicholas, Z., Kwok, C. S., …Curzen, N. (in press). Association between troponin level and medium-term mortality in 20 000 hospital patients. Heart, heartjnl-2023-322463. https://doi.org/10.1136/heartjnl-2023-322463

• Journal Article Type: Article
• Acceptance Date: Jun 20, 2023
• Online Publication Date: Aug 7, 2023
• Deposit Date: Sep 6, 2023
• Publicly Available Date: Sep 6, 2023
• Journal: Heart (British Cardiac Society)
• Print ISSN: 1355-6037
• Electronic ISSN: 1468-201X
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Pages: heartjnl-2023-322463
• DOI: https://doi.org/10.1136/heartjnl-2023-322463
• Keywords: Myocardial Infarction
• Related Public URLs: https://eprints.soton.ac.uk/478803/