Abstract 1029: Long Term Outcomes of Hospitalized Patients With an Elevated Troponin and Non-ACS Diagnosis
Background: Troponin (cTn) assays are useful in risk-stratifying patients with an acute coronary syndrome (ACS) and may have therapeutic implications for selected patients with non-ACS presentations.
Methods: By using Lab Results Files with the Veterans Affairs (VA) central data base, 386,500 VA patients were admitted in FY 2006, of which, 127,989 (33%) had a cTn assay obtained during the hospitalization. 27,486 patients were censored, because of either a DNR designation or final discharge to a hospice. Of the remaining 100,443 patients, admissions were categorized into ACS or non-ACS conditions using ICD-9 discharge diagnoses. A peak cTn result was elevated if it exceeded the 99%-tile of the reference value for the cTn assay. Outcome measures were death and re-hospitalization at 1 year following admission.
Results: A total of 24,020 patients had an elevated cTn and of those, 13,923 (58%) had a non-ACS condition (Figure⇓). Mortality was increased in patients with a non-ACS versus ACS diagnosis, and the re-hospitalization rate approached 50% (Table⇓).
Conclusion: In 2006, the majority of VA patients with elevated tpn had a non-ACS diagnosis and had a 39% higher 1-year mortality compared with patients with an ACS. The majority of patients with a non-ACS diagnosis had a primary cardiac condition, raising the question that diagnosis-related therapies in this cohort might improve outcomes.