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Impact of comorbidities on peak troponin levels and mortality in acute myocardial infarction

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Title: Impact of comorbidities on peak troponin levels and mortality in acute myocardial infarction
Authors: Sundaram, V
Rothnie, K
Bloom, C
Zakeri, R
Sahadevan, J
Singh, A
Nagai, T
Potts, J
Wedzicha, J
Smeeth, L
Simon, D
Timmis, A
Rajagopalan, S
Quint, JK
Item Type: Journal Article
Abstract: OBJECTIVES: To characterise peak cardiac troponin levels, in patients presenting with acute myocardial infarction (AMI), according to their comorbid condition and determine the influence of peak cardiac troponin (cTn) levels on mortality. METHODS: We included patients with the first admission for AMI in the UK. We used linear regression to estimate the association between eight common comorbidities (diabetes mellitus, previous angina, peripheral arterial disease, previous myocardial infarction (MI), chronic kidney disease (CKD), cerebrovascular disease, chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD)) and peak cTn. Peak cTn levels were adjusted for age, sex, smoking status and comorbidities. Logistic regression and restricted cubic spline models were employed to investigate the association between peak cTn and 180-day mortality for each comorbidity. RESULTS: 330 367 patients with ST elevation myocardial infarction and non-ST elevation myocardial infarction were identified. Adjusted peak cTn levels were significantly higher in patients with CKD (adjusted % difference in peak cTnT for CKD=42%, 95% CI 13.1 to 78.4) and significantly lower for patients with COPD, previous angina, previous MI and CHF when compared with patients without the respective comorbidities (reference group) (cTnI; COPD=-21.7%, 95% CI -29.1 to -13.4; previous angina=-24.2%, 95% CI -29.6 to -8.3; previous MI=-13.5%, 95% CI -20.6 to -5.9; CHF=-28%, 95% CI -37.2 to -17.6). Risk of 180-day mortality in most of the comorbidities did not change substantially after adjusting for peak cTn. In general, cTnI had a stronger association with mortality than cTnT. CONCLUSIONS: In this nationwide analysis of patients presenting with AMI, comorbidities substantially influenced systemic concentrations of peak cTn. Comorbid illness is a significant predictor of mortality regardless of peak cTn levels and should be taken into consideration while interpreting cTn both as a diagnostic and prognostic biomarker.
Issue Date: 14-Apr-2020
Date of Acceptance: 15-Dec-2019
URI: http://hdl.handle.net/10044/1/77257
DOI: 10.1136/heartjnl-2019-315844
ISSN: 1355-6037
Publisher: BMJ Publishing Group
Start Page: 677
End Page: 685
Journal / Book Title: Heart
Volume: 106
Issue: 9
Copyright Statement: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Sponsor/Funder: GlaxoSmithKline Services Unlimited
Funder's Grant Number: PO #3000793769
Keywords: acute myocardial infarction
acute myocardial infarction
Cardiovascular System & Hematology
1102 Cardiorespiratory Medicine and Haematology
1103 Clinical Sciences
Publication Status: Published
Conference Place: England
Online Publication Date: 2020-02-26
Appears in Collections:National Heart and Lung Institute