Elevated High-Sensitivity Troponin I in the Stabilized Phase after na Acute Coronary Syndrome Predicts All-Cause and Cardiovascular Mortality in a Highly Admixed Population: A 7-Year Cohort

Abstract

BackgroundHigh-sensitivity cardiac troponin I (hs-cTnI) has played an important role in the risk stratification of patients during the in-hospital phase of acute coronary syndrome (ACS), but few studies have determined its role as a long-term prognostic marker in the outpatient setting.ObjectiveTo investigate the association between levels of hs-cTnI measured in the subacute phase after an ACS event and long-term prognosis in a highly admixed population.MethodsWe measured levels of hs-cTnI in 525 patients 25 to 90 days after admission for an ACS event; these patients were then divided into tertiles according to hs-cTnI levels and followed for up to 7 years. We compared all-cause and cardiovascular mortality using Cox proportional hazards models and adopting a significance level of 5%.ResultsAfter a median follow-up of 51 months, patients in the highest tertile had a greater hazard ratio (HR) for all-cause mortality after adjustment for age, sex, known cardiovascular risk factors, medication use, and demographic factors (HR: 3.84, 95% CI: 1.92-8.12). These findings persisted after further adjustment for estimated glomerular filtration rate < 60 ml/min/1.73 m2 and left ventricular ejection fraction < 0.40 (HR: 6.53, 95% CI: 2.12-20.14). Cardiovascular mortality was significantly higher in the highest tertile after adjustment for age and sex (HR: 5.65, 95% CI: 1.94-16.47) and both in the first (HR: 4.90, 95% CI: 1.35-17.82) and second models of multivariate adjustment (HR: 5.89, 95% CI: 1.08-32.27).ConclusionsElevated hs-cTnI levels measured in the stabilized phase after an ACS event are independent predictors of all-cause and cardiovascular mortality in a highly admixed population.

Machine Learning-based in-hospital Mortality Prediction Models for Patients With Acute Coronary Syndrome

“…Cardiac troponin I (cTnI) was a validated biomarker for diagnosis and risk strati cation of patients with acute coronary syndrome [40]. The increase of high sensitivity-cTnI level in the stable phase after ACS event was an independent predictor of all-cause death and cardiovascular death in the ACS outpatient population [41]. In a stabilized phase of patients with non-ST-segment elevation ACS, cTnI levels exhibited a continuous and slight increase, and levels of cTnI elevated above 0.01 ug/L can predict the long-term mortality of patients [42].…”

Cohort Studies with Mortality Data from the Brazilian Population: a Rising National Requirement

“…Patients in the highest tertile of hs-cTnI had a greater hazard ratio (HR) for all-cause mortality compared to the lowest tertile, after adjustment for age, sex, known cardiovascular risk factors, medication use, and demographic factors (HR: 3.84, 95% CI: 1.92-8.12). These findings persisted after further adjustment for estimated glomerular filtration rate < 60 ml/min/1.73m 2 and left ventricular ejection fraction < 0.40 (HR: 6.53, 95% CI: 2.12-20.14). Cardiovascular mortality was significantly higher in the highest tertile after adjustment for age and sex (HR: 5.65, 95% CI: 1.94-16.47) and both in the first (HR: 4.90, 95% CI: 1.35-17.82) and second models of multivariate adjustment (HR: 5.89, 95% CI: 1.08-32.27).…”

“…The main limitation of Castro's et al 2 study is the single centre aspect. It was discussed in the manuscript, but some aspects of the results should be highlighted since they minimize this limitation.…”

“…Efforts have been made along the years by a number of research groups in Brazil and around the world to progressively generate mortality data from low-to-middle income countries that are accurate, reliable and derived from well-designed cohort studies. In this number of ABC Cardiol, Castro et al 2 published one of the many examples of these efforts.…”

Aplicação do Therapeutic Interventions Scoring System (TISS-28) em pós-operatório de cirurgia cardíaca

“…Neste sentido, medidas que visam prevenir essas doenças são primordiais para manter a qualidade e a perspectiva de vida do cliente, mesmo com os avanços tecnológicos na área cardiovascular. (De Castro, Santos, Goulart, Pereira, Staniak, Bittencourt, Lotufo & Bensenor, 2019) Nos últimos anos tem-se crescido muito o número de cirurgias cardíacas no Brasil, em especial as cirurgias de revascularização do miocárdio e correção de valvulopatias, entretanto, o número de óbitos tem crescido na mesma proporção.…”