Abstract 20492: Prognostic Significance of Minor Troponin I Elevations on 1-Year Mortality Among Patients Discharged from the Emergency Department: Results from the Troponin I in the Emergency Room (TiER) Study.
Background: The prognostic significance of minor troponin I elevations on 1-year mortality among patients evaluated and discharged from the emergency department (ED) remains uncertain.
Methods: Consecutive patients were included if they were evaluated and discharged from the ED at any of the 11 participating centers between January 2006 and December 2009. Participants were required to have at least two serial troponin I values prior to discharge from the ED. All troponin I values were obtained using the same assay (99% upper limit of normal, 0.04 ng/mL; coefficient of variation, 0.06 ng/mL). The manufacturer recommended cutoff value for diagnosis of acute myocardial infarction with this assay is 0.50 ng/mL (sensitivity, 96% specificity, 94%). The primary outcome of the analysis was all-cause mortality at 30-days. Cox-proportional hazards models were developed for both continuous and categorical troponin I values adjusted for age, gender, diabetes, hypertension, CAD, stroke, arrhythmias, chronic lung disease, thyroid disorders, and dementia.
Results: There were 12,944 patients evaluated and discharged from the ED at the participating centers with at least two serial troponin I test results. The mean age of the cohort was 58 ± 16 years, 46% were male, and 27% had diabetes. The adjusted analysis for 1-year mortality by various troponin I groups are shown in the table.
Conclusions: In a large community based cohort, even minor elevations of cardiac troponin I (>0.04) were associated with increased adjusted 1-year mortality among patients evaluated with serial troponin I and discharged from the ED. Additional risk stratification seems warranted in patients with minor troponin I elevations.
- © 2010 by American Heart Association, Inc.