Division of Cardiology, Scott & White Heart Memorial Hospital, Baylor Scott & White Health, Temple, Texas, USA
Division of Internal Medicine, Scott & White Heart Memorial Hospital, Baylor Scott & White Health, Temple, Texas. USA.
Clin Med Res. 2020 Aug;18(2-3):82-88. doi: 10.3121/cmr.2020.1513. Epub 2020 Feb 14.
Troponin values above the threshold established to diagnose acute myocardial infarction (AMI; >99th percentile) are commonly detected in patients with diagnoses other than AMI. The objective of this study was to compare inpatient mortality and 30-day readmission rate in patients with troponin I (TnI) above and below the 99th percentile in those with type 1 AMI and type 2 myocardial injury.
Between January 1, 2016 and December 31, 2016, there were 56,895 inpatient hospitalizations; of these 14,326 (25.2%) patients received troponin testing. We evaluated mortality and readmissions in the entire cohort based on the primary discharge International Classification of Diseases, Tenth Edition (ICD-10) diagnosis and grouped into type 1 AMI versus other diagnoses comprising the type 2 AMI group (including ICD-10 codes for congestive heart failure, sepsis, and other). Among those with TnI drawn, we evaluated in-hospital mortality and 30-day readmissions based on troponin values > 99th percentile (≥ 0.1 ng/ml).
Among the entire cohort, the inpatient mortality rate was significantly higher in those with TnI testing (5.0%, 95% CI 4.6%-5.3%) compared to those without testing (0.7%, 95% CI 0.6%-0.7%, P < 0.01). In the tested cohort 3,743 (26%) patients had troponin levels above the 99th percentile (> 0.1 ng/ml), and 10,583 (74%) had troponin levels below the 99th percentile (≤ 0.1 ng/ml). Comparing type 2 AMI with type 1 AMI and troponin testing, TnI values ≥ 0.1 ng/ml were associated with higher inpatient mortality (11.6% vs. 3.9%) and 30-day readmission rates (16.9% vs. 10.7%).
A higher inpatient mortality and 30-day readmission rates were found in patients with type 2 AMI compared to type 1 AMI group.
肌钙蛋白值高于诊断急性心肌梗死（AMI；>第 99 百分位数）的阈值，在除 AMI 以外的诊断中也经常被检测到。本研究的目的是比较肌钙蛋白 I（TnI）在 1 型 AMI 和 2 型心肌损伤患者中高于和低于第 99 百分位数时的住院死亡率和 30 天再入院率。
2016 年 1 月 1 日至 12 月 31 日期间，共有 56895 例住院患者，其中 14326 例（25.2%）接受了肌钙蛋白检测。我们根据主要出院国际疾病分类，第 10 版（ICD-10）诊断对整个队列进行死亡率和再入院率评估，并将其分为 1 型 AMI 与 2 型 AMI 组（包括充血性心力衰竭、败血症和其他疾病的 ICD-10 编码）。在进行 TnI 检测的患者中，我们根据肌钙蛋白值>第 99 百分位数（≥0.1ng/ml）评估住院死亡率和 30 天再入院率。
在整个队列中，TnI 检测患者的住院死亡率明显高于未检测患者（5.0%，95%CI 4.6%-5.3%比 0.7%，95%CI 0.6%-0.7%，P<0.01）。在检测队列 3 中，3743 例（26%）患者的肌钙蛋白水平高于第 99 百分位数（>0.1ng/ml），10583 例（74%）患者的肌钙蛋白水平低于第 99 百分位数（≤0.1ng/ml）。与 2 型 AMI 相比，1 型 AMI 和肌钙蛋白检测，TnI 值≥0.1ng/ml 与更高的住院死亡率（11.6%比 3.9%）和 30 天再入院率（16.9%比 10.7%）相关。
与 1 型 AMI 组相比，2 型 AMI 患者的住院死亡率和 30 天再入院率更高。
