| Outcomes and Care of Patients with Acute Heart Failure Syndromes and Cardiac Troponin Elevation. | |
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MedLine Citation:
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PMID: 23388112 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: -Cardiac troponins (cTn) may be elevated among patients with acute heart failure syndromes (AHFS). However, the optimal approach to management of AHFS with elevated cTn is unknown. METHODS AND RESULTS: -We compared the care and outcomes of 13,656 AHFS patients seeking care in the emergency department (ED) stratified by presence (cTn+, n=1845, 13.5%) or absence (cTn-) of elevated troponin. Clinically-abstracted data on patients who were admitted or discharged from the ED in Ontario, Canada (April 1999-March 2001 and April 2004-March 2007) were examined. In an exploratory 2:1 propensity-matched analysis we examined whether early coronary revascularization (within 14 days of ED visit) was associated with survival, stratified by cTn status. For cTn+ AHFS, rates of coronary angiography (21.8 versus 11.4 patients/100 person-years; p<0.001) and coronary revascularization (8.8 versus 3.2 patients/100 person-years, p<0.001) were higher than cTn-. Instantaneous 30-day adjusted hazards ratios for cTn+ versus cTn- patients were 9.17 (95%CI; 8.31-10.12, p<0.001) for death, 5.14 (95%CI; 4.66-5.67, p<0.001) for cardiovascular readmission, and 13.08 (95%CI; 10.95-15.62, p<0.001) for ischemic heart disease hospitalization. In propensity-matched analysis of 143 individuals with cTn+ AHFS, early coronary revascularization was associated with reduced mortality (adjusted HR 0.29, 95%CI; 0.09-0.92; p=0.036) compared to those who were not revascularized. Mortality was not significantly reduced amongst 210 cTn- patients undergoing early coronary revascularization (adjusted HR 0.61, 95%CI; 0.36-1.03; p=0.065). CONCLUSIONS: -Elevated cTn was associated with increased risk of death and cardiovascular hospitalizations. Highly-selected cTn+ patients who underwent early coronary revascularization for obstructive coronary artery disease experienced improved survival. |
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Authors:
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Juarez R Braga; Jack V Tu; Peter C Austin; Alice Chong; John J You; Michael E Farkouh; Heather J Ross; Douglas S Lee |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2013-2-6 |
Journal Detail:
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Title: Circulation. Heart failure Volume: - ISSN: 1941-3297 ISO Abbreviation: Circ Heart Fail Publication Date: 2013 Feb |
Date Detail:
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Created Date: 2013-2-7 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101479941 Medline TA: Circ Heart Fail Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1University of Toronto, Toronto, Canada. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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