Department of Internal Medicine, Division of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea.
Ann Med. 2022 Dec;54(1):507-515. doi: 10.1080/07853890.2022.2034934.
Cardiac troponin-I (cTnI) is a representative marker of myocardial injury. Elevation of cTnI is frequently observed in patients with hypertensive crisis, but few studies have examined its prognostic significance in hypertensive crisis. We aimed to determine whether cTnI could predict all-cause mortality in patients with hypertensive crisis visiting the emergency department (ED).
This observational study included patients aged ≥18 years who visited an ED between 2016 and 2019 for hypertensive crisis, defined as systolic blood pressure (BP) ≥180 mmHg and/or diastolic BP ≥110 mmHg. Among 6467 patients, 3938 who underwent a cTnI assay were analysed.
Among the 3938 patients, 596 (15.1%) had cTnI levels above the 99th percentile upper reference limit (elevated cTnI >40 ng/L) and 600 (15.2%) had cTnI levels between the detection limit (≥10 ng/L) and the 99th percentile upper reference limit (detectable cTnI). The 3-year all-cause mortality in the elevated, detectable and undetectable cTnI groups were 41.6%, 36.5% and 12.8%, respectively. After adjusting for confounding variables, elevated cTnI patients (adjusted hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.61-2.52) and detectable cTnI patients (adjusted HR, 1.64; 95% CI, 1.32-2.04) showed a significantly higher risk of 3-year all-cause mortality than did patients with undetectable cTnI.
In patients with hypertensive crisis, elevated cTnI levels provide useful prognostic information and permit the early identification of patients with an increased risk of death. Moreover, putatively normal but detectable cTnI levels also significantly correlated with a higher risk of all-cause mortality. Intensive treatment and follow-up strategies are needed for patients with hypertensive crisis with elevated and detectable cTnI levels.Key messagesCardiac troponin-I level was an independent prognostic factor for all-cause mortality in patients with hypertensive crisis.Detectable but normal range cardiac troponin-I, which was considered clinically insignificant, also had a prognostic impact on all-cause mortality comparable to elevated cardiac troponin-I levels.
心肌肌钙蛋白 I（cTnI）是心肌损伤的代表性标志物。在高血压危象患者中经常观察到 cTnI 升高，但很少有研究探讨其在高血压危象中的预后意义。我们旨在确定 cTnI 是否可预测就诊于急诊科（ED）的高血压危象患者的全因死亡率。
本观察性研究纳入了 2016 年至 2019 年间因高血压危象就诊 ED 的年龄≥18 岁的患者，定义为收缩压（BP）≥180mmHg 和/或舒张压（BP）≥110mmHg。在 6467 例患者中，对 3938 例行 cTnI 检测的患者进行了分析。
在 3938 例患者中，596 例（15.1%）的 cTnI 水平高于第 99 百分位上限参考范围（升高的 cTnI>40ng/L），600 例（15.2%）的 cTnI 水平处于检测限（≥10ng/L）与第 99 百分位上限参考范围之间（可检测到的 cTnI）。升高的 cTnI、可检测的 cTnI 和不可检测的 cTnI 组的 3 年全因死亡率分别为 41.6%、36.5%和 12.8%。在校正混杂变量后，升高的 cTnI 患者（校正后的危险比[HR]，2.01；95%置信区间[CI]，1.61-2.52）和可检测的 cTnI 患者（校正 HR，1.64；95%CI，1.32-2.04）的 3 年全因死亡率风险显著高于不可检测的 cTnI 患者。
在高血压危象患者中，升高的 cTnI 水平提供了有用的预后信息，并能早期识别死亡风险增加的患者。此外，检测到但处于正常范围内的 cTnI 水平与全因死亡率风险升高也显著相关。对于 cTnI 升高和可检测的高血压危象患者，需要采用强化治疗和随访策略。
