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High sensitivity troponin T in acute medicine; more questions than answers?
MedLine Citation:
PMID:  24259723     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Troponin testing in acute medicine is routine. The introduction of a high sensitivity assay (hs Tn T) has created uncertainty regarding the clinical significance of "abnormal" troponin T levels. The previous assay could not detect troponin levels <30 ng/L.Aims and METHODS: To characterize those with a hs Tn T ≥14 ng/L. Prospective cohort study of consecutive admissions to an acute medical unit.
RESULTS: Troponin was measured in 564 consecutive patients (approximately 50% of all admissions) over 1 month; was ≥14 ng/L in 224 (40%) of which 220 patients had demographic data for this analysis. Median (IQR) peak troponin was 47.5 ng/L (24-130) and 36% had a Tn T between 14 and 30ng/L. Mean (SD) age was 72 (12) years and 57% were male. Only 44 patients (20%) had an acute myocardial infarction, reflecting the increased sensitivity but reduced specificity of the assay. Prognosis was poor with 31% mortality at 1 year. Over a mean (SD) follow up of 648 (61) days there were 87 deaths (40%). Those with a primary non cardiac diagnosis (n = 126) had poorer survival than those with a primary cardiac diagnosis (n = 94). Troponin elevation related to sepsis conferred a very poor prognosis with 24 deaths (70%) over the follow up period.
CONCLUSION: Elevated hs Tn T is very common in acute medicine, but myocardial infarction as an explanation is uncommon. Overall the prognosis is poor with a tendency to worse outcomes in those with a primary "non cardiac" diagnosis.
Authors:
Colin J Petrie; Robin A P Weir; Mohamed S Anwar; Muhammad A Ali; Maria Kerr; Jehad A Abed
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-11-19
Journal Detail:
Title:  QJM : monthly journal of the Association of Physicians     Volume:  -     ISSN:  1460-2393     ISO Abbreviation:  QJM     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9438285     Medline TA:  QJM     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
* Department of Cardiology, Monklands Hospital, Monkscourt Avenue, Airdrie, ML6 0JS.
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