Ahmad Mansoor, Neilson Nathan A, Mattumpuram Jishanth, Tye Michael, Asghar Muhammad, Kim Minchul, Mungee Sudhir
Cardiology, University of Illinois Chicago, College of Medicine at Peoria, Peoria, USA.
Internal Medicine, University of Illinois Chicago, College of Medicine at Peoria, Peoria, USA.
Cureus. 2020 Dec 13;12(12):e12057. doi: 10.7759/cureus.12057.
Background and objective In patients undergoing coronary angiogram, the degree of cardiac enzyme elevation at presentation has been thought of as a strong and independent predictor of in-hospital mortality and readmission. Recent studies, however, have suggested a lack of clarity regarding this speculation, particularly with regard to troponin elevations. Additionally, the impact of troponin levels (TnI) at presentations on cost is poorly understood. In this study, we aimed to evaluate the association of Tnl at initial presentation with 30-day all-cause readmission and all-cause mortality as well as admission costs. Methods This study was a retrospective analysis of 7,388 patients who underwent coronary angiogram at our facility from 2015 to 2017. Patients were identified from a local CathPCI Registry registry, and a subsequent chart review was performed for readmission and mortality data. Cost data were provided by our in-facility finance department. We excluded patients with incomplete records and those who required coronary artery bypass grafting (CABG). After the exclusion of patients deemed ineligible, the final sample size eligible for analysis was 1,163. Patients were divided into two groups based on Tnl at presentation with a cut-off value of 0.04 ng/ml. Adjusted regression and multivariate analysis were used for clinical outcomes. Primary outcomes were 30-day readmission and mortality. The secondary outcome was the admission cost. Results Within our cohort, the average participant age was 64.6 years (SD: 12.7), and the majority of them were male (70.7%). Of these patients, 207 had lower TnI (<0.04 ng/ml), while 956 had higher TnI at presentation. The high TnI (≥0.04 ng/ml) group had a significantly higher number of patients with a family history of coronary artery disease (CAD) (13.8% vs. 7.7%: p=0.017) and those on dialysis (3.2% vs. 0.5%: p=0.028) compared to the low Tnl group. Additionally, we did not find any significant difference in 30-day mortality or readmission between the two groups in our cohort. On average, each patient in the high TnI group spent $936 more for hospital admissions compared to patients in the low Tnl group. However, this difference was not statistically significant. Conclusions Tnl at admission did not reveal a significant impact on 30-day mortality or readmission, which is consistent with the findings of previous studies. A high Tnl at admission increased the cost of admission; however, the difference was not statistically significant in our cohort.
背景与目的 在接受冠状动脉造影的患者中，就诊时心肌酶升高的程度一直被认为是院内死亡率和再入院的有力且独立的预测指标。然而，最近的研究表明这种推测尚不清楚，尤其是关于肌钙蛋白升高方面。此外，就诊时肌钙蛋白水平（TnI）对费用的影响也知之甚少。在本研究中，我们旨在评估初次就诊时TnI与30天全因再入院、全因死亡率以及入院费用之间的关联。
方法 本研究是对2015年至2017年在我们机构接受冠状动脉造影的7388例患者进行的回顾性分析。患者从当地的心脏导管介入治疗注册库中识别出来，随后对再入院和死亡率数据进行病历审查。费用数据由我们机构的财务部门提供。我们排除了记录不完整的患者以及需要冠状动脉旁路移植术（CABG）的患者。在排除不符合条件的患者后，最终符合分析条件的样本量为1163例。根据就诊时的TnI将患者分为两组，临界值为0.04 ng/ml。采用校正回归和多变量分析评估临床结局。主要结局是30天再入院和死亡率。次要结局是入院费用。
结果 在我们的队列中，参与者的平均年龄为64.6岁（标准差：12.7），其中大多数为男性（70.7%）。在这些患者中，207例患者的TnI较低（<0.04 ng/ml），而956例患者就诊时的TnI较高。与低TnI组相比，高TnI（≥0.04 ng/ml）组有冠状动脉疾病（CAD）家族史的患者数量显著更多（13.8%对7.7%：p = 0.017），以及接受透析的患者数量更多（3.2%对0.5%: p = 0.028）。此外，我们在队列中的两组患者之间未发现30天死亡率或再入院率有任何显著差异。平均而言，高TnI组的每位患者入院费用比低TnI组的患者多936美元。然而，这种差异无统计学意义。
结论 入院时的TnI对30天死亡率或再入院率未显示出显著影响，这与先前研究的结果一致。入院时高TnI会增加入院费用；然而，在我们的队列中这种差异无统计学意义。
