Iversen, Kasper4; Køber, Lars4; Gøtze, Jens Peter3; Dalsgaard, Morten3; Nielsen, Henrik3; Boesgaard, Søren3; Bay, Morten3; Kirk, Vibeke3; Nielsen, Olav Wendelboe3
1 Section of Surgery and Internal Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet2 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet3 unknown4 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet
BACKGROUND: Cardiac troponins are diagnostic markers in acute coronary syndrome and prognostic markers in stable coronary disease. Small increases are occasionally observed in patients with non-cardiac disease, but the prevalence and prognostic value of increased troponin in the general hospitalized population are unknown. METHODS: Consecutive patients aged >40years admitted to a district hospital between 1 April 1998 and 31 March 1999 were included. A comprehensive medical interview and clinical examination were performed including echocardiography and measurement of natriuretic peptides and troponin T with a high-sensitivity assay (hs-TnT). RESULTS: Serum for analyses of hs-TnT was available from 1176 patients. Patients were 73.7years old on average (interquartile range, 64.5-80.0years), 59.2% were women and median follow-up was 11.4years. The prevalence of elevated hs-TnT (> 99th percentile) was 57.1% of the entire cohort and 52.3% of patients with non-cardiac diagnoses. hs-TnT above the median (17ng/L) was associated in univariate analysis with a 3-fold higher mortality in the entire population (multivariate hazard rate (HR) from 1.3 to 1.8 for 1 and 11year mortality, respectively). In patients without past or present ischemic heart disease hs-TnT in the upper quartile (above 34.8ng/L) was associated in univariate analysis with a 5-fold higher mortality risk (multivariable HR 1.8 to 2.2 for 1 and 11year mortality, respectively). CONCLUSION: More than half of the hospitalized patients had hs-TnT levels above the 99th percentile. Elevated hs-TnT is a strong mortality risk marker in general hospitalized older patients.
International Journal of Cardiology, 2013, Vol 168, Issue 2, p. 818-24