Acute Versus Chronic Myocardial Injury and Outcomes

Myocardial Injury in the Era of High-Sensitivity Cardiac Troponin Assays

“…Of these, 29% had type 1 MI, 6.5% had type 2 MI, 29.5% had acute myocardial injury, and the majority (35%) had chronic myocardial injury. 22 In the current era of hs-assays, myocardial injury may now be the most common cause of increased cTn when examined in hospitalized patients. Using the Veterans Affairs centralized databases, McFalls et al identified patients hospitalized with increased cTn concentrations in 2006.…”

“…58 Examining outcomes among patients with myocardial injury diagnosed in the ED, Kadesjo et al found that patients with acute myocardial injury had a 21% higher risk of all-cause mortality and a 30% higher risk of HF compared to patients with chronic myocardial injury over a median follow-up of 3.9 years. 22 Myocardial injury occurs in a heterogeneous group of patients; consisting of both cardiac and non-cardiac types of insult; which likely confer different prognostic implications. A prospective study on patients with myocardial injury categorized patients based on etiology:…”

“…Notably, few epidemiological studies to date have differentiated acute from chronic myocardial injury. Examining 39 558 patients presenting to the ED with chest pain, Kadesjo et al found that 3855 patients (9.7%) had an hs-cTn concentration greater than the 99th-percentile value. Of these, 1118 (29.0%) had type 1 MI, 251 (6.5%) had type 2 MI, 1137 (29.5%) had acute myocardial injury, and the largest proportion (1349 patients [35.0%]) had chronic myocardial injury.…”

“…Furthermore, they reported that the magnitude of myocardial injury was an important factor associated with mortality, with successive increases in hazard ratios across troponin tertiles, even when adjusting for the presence of cardiovascular disease or prevalent comorbidities . Examining outcomes among patients with myocardial injury diagnosed in the ED, Kadesjo et al found that patients with acute myocardial injury had a 21% higher risk of all-cause mortality (adjusted hazard ratio, 1.21 [95% CI, 1.08-1.37]) and a 24% higher risk of HF (adjusted hazard ratio, 1.24 [95% CI, 1.07-1.43]), compared with patients with chronic myocardial injury over a median follow-up of 3.9 years.…”

“…Furthermore, they reported that the magnitude of myocardial injury was an important factor associated with mortality, with successive increases in hazard ratios across troponin tertiles, even when adjusting for the presence of cardiovascular disease or prevalent comorbidities. 58 Examining outcomes among patients with myocardial injury diagnosed in the ED, Kadesjo et al 22 found that patients with acute myocardial injury had a 21% higher risk of all-cause mortality (adjusted hazard ratio, 1.21 [95% CI, 1.08-1.37]) and a 24% higher risk of HF (adjusted haz- In all cohorts, the risk of major adverse cardiovascular events increased in a stepwise fashion across higher (assay-specific) cardiac troponin levels, with patients in the highest tertile being at particularly high risk. Patients with cardiac troponin concentrations at or less than the 99th-percentile value were used as a reference group.…”