Causes of Death in Patients With Acute and Chronic Myocardial Injury

Kadesjö, Erik; Roos, Andreas; Siddiqui, Anwar J.; Sartipy, Ulrik; Holzmann, Martin J.

doi:10.1016/j.amjmed.2019.09.030

Cited by 7 publications

(11 citation statements)

References 30 publications

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“…Troponin elevation is common in conditions other than acute coronary syndromes. A number of studies in both selected and unselected populations suggest that non-ischaemic myocardial injury is the most common cause of elevation in cardiac troponin concentration, [ 9 , 16 , 17 , 18 , 19 ], with more recent studies discriminating between acute and chronic myocardial injury [ 21 , 22 , 23 , 24 ] ( Table 1 ). In an observational cohort study of 22,589 patients who had hs-cTnT measured in a single emergency department (ED) in Sweden [ 22 , 23 ], 65% of those with elevated cardiac troponin concentrations had myocardial injury (30% acute and 35% chronic), with the remaining 35% having a diagnosis of myocardial infarction.…”

Section: Epidemiology Of Acute and Chronic Myocardial Injurymentioning

confidence: 99%

“…They observed an increase in prevalence of participants with troponin concentrations over the 99th percentile from 1 to 9% after walking. During an average of 43 [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ] months of follow up, patients with acute myocardial injury had a significantly increased risk of all-cause mortality or...…”

Section: Mechanisms Of Myocardial Injurymentioning

confidence: 99%

“…Most studies demonstrate that cardiovascular death and recurrent myocardial infarction are more common in patients with type 1 myocardial infarction, but patients with both acute and chronic myocardial injury have a substantially higher risk than those without myocardial injury [ 21 , 22 , 23 , 75 ].…”

Section: Clinical Outcomes In Patients With Myocardial Injurymentioning

confidence: 99%

“…A number of studies in both selected and unselected populations suggest that non-ischaemic myocardial injury is the most common cause of elevation in cardiac troponin concentration, [9,[16][17][18][19], with more recent studies discriminating between acute and chronic myocardial injury [21][22][23][24] (Table 1). In an observational cohort study of 22,589 patients who had hs-cTnT measured in a single emergency department (ED) in Sweden [22,23], 65% of those with elevated cardiac troponin concentrations had myocardial injury (30% acute and 35% chronic), with the remaining 35% having a diagnosis of myocardial infarction. The High-Sensitivity Troponin in the Evaluation of Patients with Suspected Acute Coronary Syndrome (High-STEACS) trial evaluated 48,282 consecutive patients with suspected acute coronary syndrome tested using a hs-cTnI assay and demonstrated that of the 9115 patients with elevated cardiac troponin concentrations, 33% had non-ischaemic myocardial injury (18% acute and 12% chronic), with the remaining 67% having a diagnosis of myocardial infarction (50% type 1 and 17% type 2 myocardial infarction).…”

Section: Epidemiology Of Acute and Chronic Myocardial Injurymentioning

confidence: 99%

“…In nearly all studies that have classified patients according to the Fourth Universal Definition of Myocardial Infarction, death from any cause was higher in patients with myocardial injury compared to type one myocardial infarction (Table 1). Outcomes are likely to be strongly influenced by the prognosis of the underlying condition responsible for myocardial injury and these patients tend to be older, with more cardiac and non-cardiac co-morbidities [19,[21][22][23][24]70,71]. titles are main study author and year as described in Table 1.…”

Section: Clinical Outcomes In Patients With Myocardial Injury 61 Mortality Outcomesmentioning

confidence: 99%

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Diagnosis, Investigation and Management of Patients with Acute and Chronic Myocardial Injury

Taggart

Wereski

Mills

2021

JCM

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The application of high-sensitivity cardiac troponins in clinical practice has led to an increase in the recognition of elevated concentrations in patients without myocardial ischaemia. The Fourth Universal Definition of Myocardial Infarction encourages clinicians to classify such patients as having an acute or chronic myocardial injury based on the presence or absence of a rise or a fall in cardiac troponin concentrations. Both conditions may be caused by a variety of cardiac and non-cardiac conditions, and evidence suggests that clinical outcomes are worse than patients with myocardial infarction due to atherosclerotic plaque rupture, with as few as one-third of patients alive at 5 years. Major adverse cardiovascular events are comparable between populations, and up to three-fold higher than healthy individuals. Despite this, no evidence-based strategies exist to guide clinicians in the investigation of non-ischaemic myocardial injury. This review explores the aetiology of myocardial injury and proposes a simple framework to guide clinicians in early assessment to identify those who may benefit from further investigation and treatment for those with cardiovascular disease.

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Section: Epidemiology Of Acute and Chronic Myocardial Injurymentioning

confidence: 99%

Section: Mechanisms Of Myocardial Injurymentioning

confidence: 99%

Section: Clinical Outcomes In Patients With Myocardial Injurymentioning

confidence: 99%

Section: Epidemiology Of Acute and Chronic Myocardial Injurymentioning

confidence: 99%

Section: Clinical Outcomes In Patients With Myocardial Injury 61 Mortality Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Diagnosis, Investigation and Management of Patients with Acute and Chronic Myocardial Injury

Taggart

Wereski

Mills

2021

JCM

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Growth Differentiation Factor 15: A Prognostic Marker in Patients with Acute Chest Pain without Acute Myocardial Infarction

et al. 2023

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Background Acute chest pain is associated with an increased risk of death and cardiovascular events even when acute myocardial infarction (AMI) has been excluded. Growth differentiation factor-15 (GDF-15) is a strong prognostic marker in patients with acute chest pain and AMI, but the prognostic value in patients without AMI is uncertain. This study sought to investigate the ability of GDF-15 to predict long-term prognosis in patients presenting with acute chest pain without AMI. Methods In total, 1320 patients admitted with acute chest pain without AMI were followed for a median of 1523 days (range: 4 to 2208 days). The primary end point was all-cause mortality. Secondary end points included cardiovascular (CV) death, future AMI, heart failure hospitalization, and new-onset atrial fibrillation (AF). Results Higher concentrations of GDF-15 were associated with increased risk of death from all causes (median concentration in non-survivors vs survivors: 2124 pg/mL vs 852 pg/mL, P < 0.001), and all secondary end points. By multivariable Cox regression, GDF-15 concentration ≥4th quartile (compared to <4th quartile) remained an independent predictor of all-cause death (adjusted hazard ratio (HR): 2.75; 95% CI, 1.69–4.45, P < 0.001), CV death (adjusted HR: 3.74; 95% CI, 1.31–10.63, P = 0.013), and heart failure hospitalization (adjusted HR: 2.60; 95% CI, 1.11–6.06, P = 0.027). Adding GDF-15 to a model consisting of established risk factors and high-sensitivity cardiac troponin T (hs-cTnT) led to a significant increase in C-statistics for prediction of all-cause mortality. Conclusions Higher concentrations of GDF-15 were associated with increased risk of mortality from all causes and risk of future CV events.

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High-Sensitivity Cardiac Troponin and the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guidelines for the Evaluation and Diagnosis of Acute Chest Pain

et al. 2022

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The 2021 American Heart Association/American College of Cardiology/American Society of Echocardiography/American College of Chest Physicians/Society for Academic Emergency Medicine/Society of Cardiovascular Computed Tomography/Society for Cardiovascular Magnetic Resonance guidelines for the evaluation and diagnosis of acute chest pain make important recommendations that include the recognition of high-sensitivity cardiac troponin (hs-cTn) as the preferred biomarker, endorsement of 99th percentile upper reference limits to define myocardial injury, and the use of clinical decision pathways, as well as acknowledgment of the uniqueness of women and other patient subsets. Details on how to integrate hs-cTn into clinical practice are less extensively addressed. Clinicians should be aware of some of the analytical aspects related to hs-cTn assays regarding the limit of detection and the limit of quantitation and how they are used clinically, especially for the single sample strategy to rule out acute myocardial infarction. Likewise, it is important for clinicians to understand issues related to the derivation of the 99th percentile upper reference limit; the value of sex-specific 99th percentile upper reference limits; how to use changing concentrations (deltas) to facilitate diagnosis and risk stratification of patients with suspected acute coronary syndrome, including the differentiation of acute from chronic myocardial injury; and how to best integrate the use of hs-cTn with clinical decision pathways. With the use of hs-cTn, conditions such as type 2 myocardial infarction become more common, whereas others such as unstable angina become less frequent but still occur. Sections relating to these issues are included.

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Causes of Death in Patients With Acute and Chronic Myocardial Injury

Cited by 7 publications

References 30 publications

Diagnosis, Investigation and Management of Patients with Acute and Chronic Myocardial Injury

Diagnosis, Investigation and Management of Patients with Acute and Chronic Myocardial Injury

Growth Differentiation Factor 15: A Prognostic Marker in Patients with Acute Chest Pain without Acute Myocardial Infarction

High-Sensitivity Cardiac Troponin and the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guidelines for the Evaluation and Diagnosis of Acute Chest Pain

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