HIGH-SENSITIVITY CARDIAC TROPONIN I AS PROGNOSTIC INDICATOR FOR SUBSEQUENT ADVERSE CARDIAC EVENTS IN PATIENTS WITHOUT ACUTE MYOCARDIAL INFARCTION

ARLIZAN BAIZURA BINTI ARIFFIN, ARLIZAN BAIZURA (2021) HIGH-SENSITIVITY CARDIAC TROPONIN I AS PROGNOSTIC INDICATOR FOR SUBSEQUENT ADVERSE CARDIAC EVENTS IN PATIENTS WITHOUT ACUTE MYOCARDIAL INFARCTION. Doctoral thesis, UNIVERSITI KEBANGSAAN MALAYSIA.

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Abstract

Introduction: High-sensitivity cardiac troponin (hs-cTn) assays are the preferred biomarker for the diagnosis and prognostication of acute myocardial infarction (AMI). However, the prognostic value of hs-cTn in patients who do not fulfilled the criteria of AMI (non-AMI) is lacking. Objective: We aimed to investigate the prognostic value of single baseline hs-cTn I level for subsequent adverse cardiac events (ACE) and all-cause mortality in non-AMI patients. Methods: In this retrospective study, patients who presented to the emergency department between 2016 to 2018 with non-AMI were included (n=732) and stratified into three groups based on hs-cTn I levels: < Limit of Quantitation (<LoQ; lO.Opg/ml), between LoQ to gender-specific 99th percentile upper reference limit (URL; male: 34.2pg/ml, female: 15.6pg/ml) and above the 99th percentile URL. Medical records were reviewed to look for the presence of subsequent ACE or all-cause mortality within 12 months from index presentation. Descriptive statistics, Kaplan-Meier and Cox Regression analyses were carried out. Results: Patients with hs-cTn I level above the 99th percentile URL (median 51.9pg/ml, p<0.001) had reduced estimated mean time until subsequent ACE (10.9 months, 95% confidence interval (CI) 10.6-11.4). Higher ACE hazard was observed in hs-cTn I above the 99th percentile URL (hazard ratio (HR) 5.41, 95% CI 1.951-15.003), male gender (HR 2.619, 95% CI 1.305-5.254) and cardiac-related diagnosis (HR 2.412, 95% CI 1.151-5.054). All-cause mortality hazard was increased by 2.7% for each year increase of patient’s age and higher in patients with history of cerebrovascular accident (CVA) (HR 2.375,95% C1 1.283 - 4.395). Conclusion: Elevated hs-cTn I level above the 99th percentile URL, male gender and cardiac-related diagnosis were associated with increased risk for subsequent ACE during the 12 months follow-up in non-AMI patients. Increased age and history of CVA were associated with increased risk of all-cause mortality

Item Type:	Thesis (Doctoral)
Subjects:	R Medicine > R Medicine (General)
Divisions:	Universiti > Universiti Kebangsaan Malaysia (UKM)
Depositing User:	Encik Mohd Zulkarnain Hassan bin Mohd Zainudin
Date Deposited:	16 Oct 2024 15:13
Last Modified:	16 Oct 2024 15:13
URI:	https://repositori.mohe.gov.my/id/eprint/19

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