Early and late mortality in hospitalised patients with raised cardiac troponin T
- Peter Sze Chai Wong1,
- Julia Dawn Jones1,
- Reza Ashrafi1,
- Omer Khanzada1,
- Upul Wickramarachchi1,
- Touran Heidi Keen1,
- Derek Richard Robinson2
- 1Aintree Cardiac Centre, University Hospital Aintree, Liverpool, UK
- 2Department of Mathematics, School of Mathematical and Physical Sciences, University of Sussex, Brighton, UK
- Correspondence to Dr Peter Sze Chai Wong, Aintree Cardiac Centre, University Hospital Aintree, Liverpool, Merseyside L9 7AL, UK;
- Received 22 September 2011
- Accepted 25 March 2012
- Published Online First 27 April 2012
Aims Cardiac troponins are measured in acute coronary syndrome (ACS) and other conditions. The authors investigate the prognostic significance of cardiac troponin T (TnT) test and comorbid medical conditions.
Methods Consecutive patients admitted to the Aintree University Hospital, Liverpool, between 2 January 2004 and 29 February 2004 who had TnT measurement were included. Patients were separated into normal (<0.01 μg/l) or raised TnT levels (≥0.01 μg/l), and further categorised into: (1) normal TnT with unstable angina; (2) normal TnT with non-ACS; (3) raised TnT with ACS; and (4) raised TnT with non-ACS. Cox regression was used to identify prognostic variables, and logrank test to compare 7-year survival.
Results Of 1021 patients, 313 had raised TnT (195 ACS, 118 non-ACS) and 708 normal TnT (80 ACS, 628 non-ACS). Age (HR 1.06; 95% CI 1.05 to 1.07), congestive cardiac failure (HR 1.37; 95% CI 1.11 to 1.69), cerebrovascular disease (HR 1.37; 95% CI 1.10 to 1.71), chronic obstructive airway disease (HR 1.44; 95% CI 1.19 to 1.75), liver disease (HR 4.16; 95% CI 2.37 to 7.31), renal disease (HR 1.83; 95% CI 1.27 to 2.64), tumour (HR 1.39; 95% CI 1.07 to 1.79), lymphoma (HR 4.81; 95% CI 2.07 to 11.16), metastatic cancer (HR 3.55; 95% CI 2.32 to 5.45) and a higher Charlson's comorbidity score (HR 1.20, 95% CI 1.13 to 1.26) were adverse predictors. Both raised TnT with ACS (HR 1.92, 95% CI 1.54 to 2.39) and raised TnT with non-ACS (HR 2.37, 95% CI 1.87 to 3.00) were associated with worse survival. Raised TnT with non-ACS had a worse survival than raised TnT with ACS (p=0.001).
Conclusion Hospitalised patients with raised TnT levels from any cause predicted a higher mortality than normal TnT, with worst survival in those without an obvious ACS.
- Troponin T
- acute coronary syndrome
- non-acute coronary syndrome
- adult cardiology
- valvular heart disease
Competing interests None.
Ethics approval Original study was approved by the local Sefton Local Ethics Committee. Previous communication with Local Ethics chairman suggested that the original study could have been performed as an audit and was also published as a clinical audit.8 Patient management was not changed as a result of the study.
Provenance and peer review Not commissioned; externally peer reviewed.