Prognostic Significance of Elevated Baseline Troponin in Patients With Acute Coronary Syndromes and Chronic Kidney Disease Treated With Different Antithrombotic Regimens

Acharji, Subasit; Baber, Usman; Mehran, Roxana; Fahy, Martin; Kirtane, Ajay J.; Lansky, Alexandra J.; Stone, Gregg W.

doi:10.1161/circinterventions.111.963876

Cited by 19 publications

(16 citation statements)

References 39 publications

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“…No significant difference was observed in Troponin I level between patients with or without development of arrhythmia, conduction defect and death (p>0.05). These observations are in consistent with the findings of the trial by Acharji [15][16][17] . Diderholm et al (2002) observed that troponin I level is an effective prognostic marker and its level predicts in-hospital out come in NSTEMI.…”

Section: Discussionsupporting

confidence: 93%

Demographic Profile of NSTEMI (Non ST Elevation Myocardial Infarction) Patients & Association of ST-Segment Depression and Level of Troponin I with NSTEMI Patient's In-Hospital Outcome

Zahid¹,

Khan

Chowdhury

et al. 2016

Med. Today

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Acute coronary syndrome (ACS) remains the leading cause of death in the developed world and second leading cause of death in developing countries. Elevated troponin levels and extent of ST-segment depressions are clinically important because they may act as an effective prognostic marker .This cross-sectional study has been designed to see the correlation of ST-segment depression and level of troponin I with in-hospital outcome of NSTEMI patients. The study was conducted in the Department of Cardiology, Dhaka Medical College Hospital, Dhaka during the period of April, 2011- March, 2012. A total of 90 patients were selected by purposive sampling. In this study,the mean ±SD age of the patients was 55.9±9.1 years with a range of 36-80 years with a male -female ratio of 2:1.Over all dyslipidaemia was the most common risk factor present in 55(61.10%) patients followed by smoking in 48(53.3%) patients then obesity in 32(35.60%) then hypertension in 31(34.4%) patients. Troponin I level was significantly high in patients who developed acute LVF (10.36±7.4 vs 7.0124±6.8, p=.027), and cardiogenic shock (13.72±11.37 vs 8.64±7.35, p=.033). Troponin I was significantly high in patients who developed complication (10.72±8.84 vs 6.24±5.41, p=.005) than the patients who were discharged without complication. ST segment depression was significantly more in patients who developed acute LVF(1.07±1.63 vs.55±.74, p=.048). Logistic regression analysis of acute LVF with Troponin I and ST-segment depression showed that ST-segment depression and level of Troponin I were important correlates of acute LVF .Medicine Today 2015 Vol.27(2): 14-19

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Section: Discussionsupporting

confidence: 93%

Demographic Profile of NSTEMI (Non ST Elevation Myocardial Infarction) Patients & Association of ST-Segment Depression and Level of Troponin I with NSTEMI Patient's In-Hospital Outcome

Zahid¹,

Khan

Chowdhury

et al. 2016

Med. Today

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“…In a substudy of Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial, Acharji et al [50] aimed to show the prognostic value of baseline troponin levels of 2179 CKD patients with moderate and high risk of ACS. Of 2179 CKD patients, 1291 had elevated baseline troponin (59.2%).…”

Section: Clinical Studies Of Cad In Ckd Patientsmentioning

confidence: 99%

An Update on Coronary Artery Disease and Chronic Kidney Disease

Afsar

Türkmen

Covic

et al. 2014

International Journal of Nephrology

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Despite the improvements in diagnostic tools and medical applications, cardiovascular diseases (CVD), especially coronary artery disease (CAD), remain the most common cause of morbidity and mortality in patients with chronic kidney disease (CKD). The main factors for the heightened risk in this population, beside advanced age and a high proportion of diabetes and hypertension, are malnutrition, chronic inflammation, accelerated atherosclerosis, endothelial dysfunction, coronary artery calcification, left ventricular structural and functional abnormalities, and bone mineral disorders. Chronic kidney disease is now recognized as an independent risk factor for CAD. In community-based studies, decreased glomerular filtration rate (GFR) and proteinuria were both found to be independently associated with CAD. This paper will discuss classical and recent epidemiologic, pathophysiologic, and clinical aspects of CAD in CKD patients.

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“…population deserve further study, and should extend beyond the perioperative space. 24 Current guidelines from the American College of Cardiology/American Heart Association advise measuring troponin levels in patients undergoing noncardiac surgery with signs of symptoms of ischemia (Class I recommendation), and both these American College of Cardiology/American Heart Association and the European Society of Cardiology/Heart Association Guidelines give a weak recommendation for routine troponin screening in patients at high risk for perioperative cardiovascular events (Class IIb recommendation). 25,26 While in our study the hazard of mortality was similar in patients not sampled compared to those who were sampled but below the 99th percentile (<0.01 ng/mL), these results are contrary to strong evidence that in the absence of routine troponin sampling, 85% of prognostically important myocardial injuries after noncardiac surgery may be undetected.…”

Section: Discussionmentioning

confidence: 99%

Associations Between Cardiac Troponin, Mechanism of Myocardial Injury, and Long‐Term Mortality After Noncardiac Vascular Surgery

Reed

Horr

Young

et al. 2017

JAHA

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BackgroundThe time‐sensitive hazard of perioperative cardiac troponin T (cTnT) elevation and whether long‐term mortality differs by mechanism of myocardial injury are poorly understood.Methods and ResultsIn this observational study of 12 882 patients who underwent noncardiac vascular surgery, patients were assessed for cTnT sampling within 96 hours postoperatively. Mortality out to 5‐years was stratified by cTnT level and mechanism of myocardial injury. During a median follow‐up of 26.9 months, there were 2149 (16.7%) deaths. By multivariable Cox proportional hazards analysis, there was a graded increase in mortality with any detectable cTnT compared to <0.01 ng/mL; cTnT 0.01 to 0.029 ng/mL hazard ratio (HR) 1.54 (95% CI 1.18–2.00, P=0.002), 0.03 to 0.099 ng/mL HR 1.86 (95% CI 1.49–2.31, P<0.001), 0.10 to 0.399 ng/mL HR 1.83 (95% CI 1.46–2.31, P<0.001), ≥0.40 ng/mL HR 2.62 (95% CI 2.06–3.32, P<0.001). Mortality for each mechanism of injury was greater than for patients with normal cTnT; baseline cTnT elevation HR 1.71 (95% CI 1.31–2.24; P<0.001), Type 2 myocardial infarction HR 1.88 (95% CI 1.57–2.24; P<0.001), Type 1 MI HR 2.56 (95% CI 2.56, 1.82–3.60; P<0.001). On Kaplan–Meier analysis, long‐term survival did not differ between mechanisms. The hazard of mortality was greatest within the first 10 months postsurgery. Consistent results were obtained in confirmatory propensity‐score matched analyses.ConclusionsAny detectable cTnT ≥0.01 ng/mL is associated with increased long‐term mortality after vascular surgery. This risk is greatest within the first 10 months postoperatively. While short‐term mortality is greatest with Type 1 myocardial infarction, long‐term mortality appears independent of the mechanism of injury.

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Prognostic Significance of Elevated Baseline Troponin in Patients With Acute Coronary Syndromes and Chronic Kidney Disease Treated With Different Antithrombotic Regimens

Abstract: Background-Elevation of baseline cardiac troponin in patients presenting with acute coronary syndromes (ACS) confers an adverse prognosis. The prognostic value of troponin elevation in patients with chronic kidney disease (CKD) and ACS is less certain.

Cited by 19 publications

References 39 publications

Demographic Profile of NSTEMI (Non ST Elevation Myocardial Infarction) Patients & Association of ST-Segment Depression and Level of Troponin I with NSTEMI Patient's In-Hospital Outcome

Demographic Profile of NSTEMI (Non ST Elevation Myocardial Infarction) Patients & Association of ST-Segment Depression and Level of Troponin I with NSTEMI Patient's In-Hospital Outcome

An Update on Coronary Artery Disease and Chronic Kidney Disease

Associations Between Cardiac Troponin, Mechanism of Myocardial Injury, and Long‐Term Mortality After Noncardiac Vascular Surgery

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