Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17 Avenue, B130, Aurora, CO, 80045, USA.
Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
BMC Cardiovasc Disord. 2023 Mar 24;23(1):151. doi: 10.1186/s12872-023-03168-0.
Serum troponin levels correlate with the extent of myocyte necrosis in acute myocardial infarction (AMI) and predict adverse outcomes. However, thresholds of cardiac troponin elevation that could portend to poor outcomes have not been established.
In this cohort study, we characterized all cardiac troponin elevations > 0.04 ng/mL (upper limit of normal [ULN]) from patients hospitalized with an ICD-9/10 diagnosis of AMI across our health system from 2012-2019. We grouped events into exponential categories of peak cardiac troponin and evaluated the association of these troponin categories with all-cause mortality, heart transplants, or durable left ventricular assist devices (LVAD). Patients with cardiac troponin > 10,000 × ULN were manually chart reviewed and described.
There were 18,194 AMI hospitalizations with elevated cardiac troponin. Peak troponin was 1-10 × ULN in 21.1%, 10-100 × ULN in 34.8%, 100-1,000 × ULN in 30.1%, 1,000-10,000 × ULN in 13.1%, and > 10,000 × ULN in 0.9% of patients. One-year mortality was 17-21% across groups, except in > 10,000 × ULN group where it was 33% (adjusted hazard ratio (99%CI) for > 10,000 × ULN group compared to all others: 1.86 (1.21, 2.86)). Hazards of one-year transplant and MCS were also significantly elevated in the > 10,000 × ULN group.
Elevation in cardiac troponin levels post AMI that are > 10,000 × ULN was rare but identified patients at particularly high risk of adverse events. These patients may benefit from clarification of goals of care and early referral for advanced heart failure therapies. These data have implications for conversion to newer high-sensitivity cardiac troponin assays whose maximum assay limit is often lower than traditional assays.
肌钙蛋白血清水平与急性心肌梗死（AMI）中心肌细胞坏死的程度相关，并可预测不良预后。然而，能够预示不良结局的心脏肌钙蛋白升高的阈值尚未确定。
在这项队列研究中，我们对我院 2012 年至 2019 年间所有因 ICD-9/10 诊断为 AMI 住院的患者中肌钙蛋白升高超过 0.04ng/mL（正常值上限[ULN]）的患者进行了特征描述。我们将事件分为峰值肌钙蛋白的指数类别，并评估这些肌钙蛋白类别与全因死亡率、心脏移植或耐用性左心室辅助装置（LVAD）的关系。肌钙蛋白超过 10,000×ULN 的患者进行了手动图表审查并进行了描述。
共有 18194 例 AMI 住院患者肌钙蛋白升高。峰值肌钙蛋白为 1-10×ULN 的占 21.1%，10-100×ULN 的占 34.8%，100-1000×ULN 的占 30.1%，1000-10000×ULN 的占 13.1%，>10000×ULN 的占 0.9%。除了>10000×ULN 组的死亡率为 33%（与其他所有组相比，>10000×ULN 组的调整后的危险比[99%CI]：1.86[1.21,2.86]）外，其余各组的 1 年死亡率均为 17-21%。>10000×ULN 组的 1 年移植和 MCS 的风险也显著升高。
AMI 后心脏肌钙蛋白升高超过 10000×ULN 虽然罕见，但确定了发生不良事件风险特别高的患者。这些患者可能受益于明确治疗目标，并早期转介接受先进的心力衰竭治疗。这些数据对转化为新的高灵敏度心脏肌钙蛋白检测具有影响，这些检测的最大检测限通常低于传统检测。
