Long-Term Prognostic Significance of High-Sensitive Troponin I Increase during Hospital Stay in Patients with Acute Myocardial Infarction and Non-Obstructive Coronary Arteries
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Markers of Myocardial Injury
2.3. Working Diagnosis, Etiology, and Discharge Diagnosis
2.4. Echocardiography
2.5. Coronary Angiography
2.6. Study Endpoints
2.7. Statistical Analysis
3. Results
3.1. General Characteristics
3.2. Clinical Characteristics
3.3. Biochemical Parameters
3.4. Type of Acute Coronary Syndrome, Electrocardiography, and Echocardiography
3.5. Coronary Artery Angiography
3.6. Working Etiology and Discharge Diagnosis
3.7. Clinical Outcomes
3.8. Predictors of Clinical Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Clinical Characteristics | Concentration of High-Sensitivity Cardiac I Troponin (Increase—Times above the Upper Normal Limit) | p-Value | ||
---|---|---|---|---|
≤5 | >5 to ≤20 | >20 | ||
Age, years | 69.1 ± 10.6 | 63.9 ± 12.9 | 62.6 ± 16.4 | 0.008 |
Hospitalization duration, days | 4.58 ± 2.38 | 5.38 ± 3.45 | 6.06 ± 3.42 | 0.02 |
Gender, female | 41 (47.1) | 39 (50.6) | 79 (45.7) | 0.76 |
Arterial hypertension | 72 (83.7) | 64 (83,1) | 116 (67.8) | 0.004 |
Hyperlipidemia | 57 (66.3) | 35 (45.4) | 61 (35.9) | <0.001 |
Diabetes | 30 (34.9) | 16 (20.8) | 38 (22.2) | 0.052 |
Kidney failure | 15 (17.6) | 7 (9.1) | 19 (11.2) | 0.2 |
Atrial fibrillation | 17 (19.5) | 15 (19.5) | 25 (14.5) | 0.46 |
COPD/Asthma | 9 (10.5) | 8 (10.4) | 14 (8.2) | 0.77 |
Autoimmune disease | 2 (2,3) | 5 (6.5) | 7 (4.1) | 0.45 |
Oncological disease | 8 (9.3) | 7 (9.1) | 11 (6.5) | 0.65 |
Hypercoagulable state | 6 (7) | 3 (3.9) | 3 (1.8) | 0.13 |
Smoking | 22 (26.5) | 19 (35.2) | 12 (29.3) | 0.55 |
Alcohol abuse | 2 (2.3) | 2 (2.6) | 7 (4.3) | 0.67 |
Prior myocardial infarction | 30 (34.5) | 16 (20.8) | 37 (21.5) | 0.04 |
Prior PCI | 32 (36.8) | 12 (15.6) | 27 (15.8) | <0.001 |
Cardiac arrest | 3 (3.4) | 0 (0) | 15 (8.8) | 0.01 |
Prior cerebral stroke/TIA | 6 (6.9) | 4 (5.2) | 12 (7) | 0.86 |
Prior DVT/PE | 2 (2.3) | 0 (0) | 4 (2.3) | 0.4 |
Pharmacotherapy | ||||
Acetyl salicylic acid | 33 (55) | 26 (42.6) | 33 (22.9) | 0.04 |
P2Y12 blockers | 14 (25) | 8 (13.6) | 10 (7) | 0.002 |
Anticoagulants | 17 (28.3) | 15 (25) | 14 (9.9) | 0.001 |
Beta-blocker | 38 (59.4) | 28 (43.7) | 42 (29.2) | <0.001 |
Statins | 38 (59.4) | 27 (44.3) | 36 (25) | <0.001 |
Biochemical Analyses | ||||
White blood cells, 103/µL | 8.18 ± 2.98 | 8.8 ± 3.12 | 9.98 ± 4.8 | 0.02 |
Platelet count,·103/µL | 225.9 ± 98 | 239.8 ± 79.8 | 220.5 ± 79.8 | 0.12 |
Hemoglobin, g/dL | 13.5 ± 1.6 | 13.1 ± 1.8 | 12.9 ± 2.1 | 0.15 |
C-reactive protein, mg/L | 13.3 ± 9.8 | 44.4 ± 53.9 | 41.1 ± 59.1 | 0.16 |
Total Cholesterol, mmol/L | 4.15 ± 1.02 | 4.75 ± 1.1 | 4.5 ± 1.1 | 0.01 |
Cholesterol HDL, mmol/L | 1.25 ± 0.4 | 1.34 ± 0.4 | 1.24 ± 0.4 | 0.45 |
Cholesterol LDL, mmol/L | 2.24 ± 0.8 | 2.66 ± 1 | 2.58 ± 1.1 | 0.4 |
Triglycerides, mmol/L | 1.48 ± 0.8 | 1.68 ± 1.1 | 1.49 ± 0.8 | 0.79 |
eGFR < 60 mL/min. | 20 (25.6) | 13 (19.1) | 34 (25.9) | 0.53 |
Creatinine, µmol/L | 76.5 ± 34.6 | 68.9 ± 14.5 | 83.56 ± 43.9 | 0.23 |
CK-MB at admission, U/I | 1.5 ± 3.1 | 11.7 ± 15.2 | 44 ± 75 | <0.001 |
CK-MB max., U/I | 30.4 ± 23.1 | 28.1 ± 16.4 | 68.6 ± 160 | <0.001 |
Concentration of High-Sensitivity Cardiac I Troponin (Increase—Times above the Upper Normal Limit) | p-Value | |||
---|---|---|---|---|
≤5 | >5 to ≤20 | >20 | ||
Type of Myocardial Infarction at Admission—Working Diagnosis | ||||
STEMI | 8 (9.3) | 9 (11.5) | 37 (21.4) | <0.001 |
NSTEMI | 69 (80.2) | 68 (87.2) | 136 (78.6) | |
Unstable angina | 9 (10.5) | 0 | 0 | |
Electrocardiography | ||||
ST segment elevation/LBBB | 13 (15.3) | 18 (23.4) | 44 (25.6) | 0.17 |
ST segment depression | 21 (24.7) | 20 (26) | 29 (16.9) | 0.16 |
T-wave inversion | 15 (20.3) | 14 (18.7) | 34 (20.1) | 0.95 |
Echocardiography | ||||
LVEF ≥ 40% | 49 (59.8) | 60 (80) | 114 (66,67) | 0.02 |
Mean LVEF | 43.6 ±15.8 | 52.1 ±11.8 | 47.8 ±14.3 | 0.001 |
Normal contractility | 33 (39.8) | 30 (40) | 41 (24.4) | 0.01 |
Present hypokinesis | 32 (38.5) | 26 (35.1) | 72 (42.9) | 0.05 |
Present akinesis | 18 (21.7) | 18 (24.3) | 55 (32.7) | 0.13 |
Pericardial effusion | 2 (2.4) | 5 (6.8) | 15 (8.9) | 0.15 |
Coronary Angiography | ||||
Vascular access, radial | 65 (75.6) | 54 (76.1) | 115 (78.8) | 0.82 |
Non-stenotic plaques | 65 (74.6) | 59 (76.6) | 119 (75.8) | 0.95 |
Slow-flow contrasts | 2 (2.3) | 4 (5.2) | 19 (11) | 0.02 |
Eccentric plaque | 2 (2.3) | 3 (3.9) | 1 (0.6) | 0.17 |
Myocardial bridges | 4 (4.6) | 4 (5.2) | 10 (5.8) | 0.92 |
Arterial spasm | 1 (1.1) | 0 (0) | 5 (2.9) | 0.42 |
Thrombus | 0 (0) | 0 (0) | 2 (1.1) | 0.38 |
Etiology | Concentration of High-Sensitivity Cardiac I Troponin (Increase—Times above the Upper Normal Limit) | p-Value | ||
---|---|---|---|---|
≤5 | >5 to ≤20 | >20 | ||
Unknown | 14 (16.1) | 18 (23.4) | 58 (33.4) | 0.008 |
Arterial spasm | 0 (0) | 1 (1.3) | 4 (2.3) | 0.34 |
Myocarditis | 1 (1.2) | 5 (6.5) | 14 (8.1) | 0.07 |
HCM | 2 (2.3) | 1 (1.3) | 2 (1.2) | 0.76 |
Takotsubo cardiomyopathy | 0 (0) | 4 (5.2) | 27 (15.5) | <0.001 |
Slow-flow phenomenon | 0 (0) | 2 (2.6) | 8 (4.6) | 0.11 |
AV conduction disorders | 3 (3.4) | 3 (3.9) | 2 (1.2) | 0.31 |
Aortic dissection | 0 (0) | 1 (1.3) | 1 (0.6) | 0.55 |
Tachyarrhythmias | 10 (12.6) | 6 (7.8) | 19 (11) | 0.69 |
Atrial fibrillation | 10 (12.6) | 6 (7.8) | 15 (8.7) | 0.67 |
Arterial hypertension | 13 (14.9) | 9 (11.7) | 4 (2.3) | <0.001 |
Anemia | 0 (0) | 0 (0) | 2 (1.2) | 0.38 |
Oncological embolization | 1 (1.2) | 1 (1.3) | 3 (1.7) | 0.92 |
Myocardial bridge | 2 (2.3) | 2 (2.6) | 3 (1.7) | 0.89 |
PE/DVT | 0 (0) | 0 (0) | 1 (0.6) | 0.62 |
Muscular dystrophy | 0 (0) | 0 (0) | 1 (0.6) | 0.62 |
Cerebral stroke | 0 (0) | 0 (0) | 1 (0.6) | 0.62 |
Alcoholic cardiomyopathy | 0 (0) | 0 (0) | 1 (0.6) | 0.62 |
Aortic valve stenosis | 2 (2.3) | 1 (1.3) | 2 (1.2) | 0.76 |
Antiphospholipid syndrome | 0 (0) | 0 (0) | 1 (0.6) | 0.62 |
Vasculitis | 0 (0) | 0 (0) | 1 (0.6) | 0.62 |
Selected Indices | Concentration of High-Sensitivity Cardiac I Troponin (Increase—Times above the Upper Normal Limit) | p-Value | ||
---|---|---|---|---|
≤5 | >5 to ≤20 | >20 | ||
Diagnosis at Discharge from Hospital | ||||
Myocarditis | 1 (1.1) | 4 (5.2) | 13 (7.5) | 0.09 |
Takotsubo cardiomyopathy | 0 (0) | 1 (1.3) | 21 (12.1) | <0.001 |
Arrhythmias | 5 (5.8) | 5 (6.5) | 4 (2.3) | 0.21 |
Atrial fibrillation | 5 (5.8) | 5 (6.5) | 3 (1.7) | 0.11 |
Arterial hypertension | 7 (8.1) | 5 (6.5) | 2 (1.2) | 0.01 |
Venous thromboembolic disease | 0 (0) | 0 (0) | 1 (0.6) | 0.62 |
NSTEMI | 38 (43.7) | 47 (61) | 83 (48) | 0.06 |
STEMI | 3 (3.4) | 4 (5.2) | 14 (8.1) | 0.31 |
Heart failure | 27 (31) | 3 (3.9) | 20 (11.5) | <0.001 |
Type 2 myocardial infarction | 5 (5.8) | 6 (7.8) | 12 (6.9) | 0.87 |
Hypertrophic cardiomyopathy | 1 (1.1) | 1 (1.3) | 1 (0.6) | 0.81 |
Myocardial bridge | 0 (0) | 1 (1.3) | 1 (0.6) | 0.55 |
Cerebral stroke | 0 (0) | 0 (0) | 1 (0.6) | 0.62 |
Follow-Up | ||||
Mean time of follow-up, days | 482 ± 173 | 461 ± 245 | 566 ± 382 | 0.23 |
MACCE | 4 (4.6) | 7 (9.4) | 28 (18.4) | 0.005 |
Overall all-cause mortality | 1 (1.1) | 3 (4) | 20 (13.1) | 0.001 |
In-hospital all-cause mortality | 1 (1.1) | 1 (1.3) | 6 (3.5) | 0.39 |
Myocardial infarction | 4 (4.6) | 3 (4) | 24 (15.8) | 0.003 |
PCI | 0 (0) | 0 (0) | 4 (2.6) | 0.11 |
Cerebral stroke/TIA | 0 (0) | 3 (4) | 0 (0) | 0.007 |
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Jędrychowska, M.; Januszek, R.; Wańha, W.; Malinowski, K.P.; Kunik, P.; Trznadel, A.; Bartuś, J.; Staszczak, B.; Januszek, S.M.; Kameczura, T.; et al. Long-Term Prognostic Significance of High-Sensitive Troponin I Increase during Hospital Stay in Patients with Acute Myocardial Infarction and Non-Obstructive Coronary Arteries. Medicina 2020, 56, 432. https://doi.org/10.3390/medicina56090432
Jędrychowska M, Januszek R, Wańha W, Malinowski KP, Kunik P, Trznadel A, Bartuś J, Staszczak B, Januszek SM, Kameczura T, et al. Long-Term Prognostic Significance of High-Sensitive Troponin I Increase during Hospital Stay in Patients with Acute Myocardial Infarction and Non-Obstructive Coronary Arteries. Medicina. 2020; 56(9):432. https://doi.org/10.3390/medicina56090432
Chicago/Turabian StyleJędrychowska, Magdalena, Rafał Januszek, Wojciech Wańha, Krzysztof Piotr Malinowski, Piotr Kunik, Agata Trznadel, Joanna Bartuś, Bartłomiej Staszczak, Sławomir Mateusz Januszek, Tomasz Kameczura, and et al. 2020. "Long-Term Prognostic Significance of High-Sensitive Troponin I Increase during Hospital Stay in Patients with Acute Myocardial Infarction and Non-Obstructive Coronary Arteries" Medicina 56, no. 9: 432. https://doi.org/10.3390/medicina56090432