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Outcomes and Care of Patients with Acute Heart Failure Syndromes and Cardiac Troponin Elevation.
MedLine Citation:
PMID:  23388112     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  JOURNAL ARTICLE     Date:  2013-2-6
Journal Detail:
Title:  Circulation. Heart failure     Volume:  -     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1University of Toronto, Toronto, Canada.
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