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@article{Sundaram:2020:10.1136/heartjnl-2019-315844,
author = {Sundaram, V and Rothnie, K and Bloom, C and Zakeri, R and Sahadevan, J and Singh, A and Nagai, T and Potts, J and Wedzicha, J and Smeeth, L and Simon, D and Timmis, A and Rajagopalan, S and Quint, JK},
doi = {10.1136/heartjnl-2019-315844},
journal = {Heart},
pages = {677--685},
title = {Impact of comorbidities on peak troponin levels and mortality in acute myocardial infarction},
url = {http://dx.doi.org/10.1136/heartjnl-2019-315844},
volume = {106},
year = {2020}
}

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TY  - JOUR
AB  - OBJECTIVES: To characterise peak cardiac troponin levels, in patients presenting with acute myocardial infarction (AMI), according to their comorbid condition and determine the influence of peak cardiac troponin (cTn) levels on mortality. METHODS: We included patients with the first admission for AMI in the UK. We used linear regression to estimate the association between eight common comorbidities (diabetes mellitus, previous angina, peripheral arterial disease, previous myocardial infarction (MI), chronic kidney disease (CKD), cerebrovascular disease, chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD)) and peak cTn. Peak cTn levels were adjusted for age, sex, smoking status and comorbidities. Logistic regression and restricted cubic spline models were employed to investigate the association between peak cTn and 180-day mortality for each comorbidity. RESULTS: 330 367 patients with ST elevation myocardial infarction and non-ST elevation myocardial infarction were identified. Adjusted peak cTn levels were significantly higher in patients with CKD (adjusted % difference in peak cTnT for CKD=42%, 95% CI 13.1 to 78.4) and significantly lower for patients with COPD, previous angina, previous MI and CHF when compared with patients without the respective comorbidities (reference group) (cTnI; COPD=-21.7%, 95% CI -29.1 to -13.4; previous angina=-24.2%, 95% CI -29.6 to -8.3; previous MI=-13.5%, 95% CI -20.6 to -5.9; CHF=-28%, 95% CI -37.2 to -17.6). Risk of 180-day mortality in most of the comorbidities did not change substantially after adjusting for peak cTn. In general, cTnI had a stronger association with mortality than cTnT. CONCLUSIONS: In this nationwide analysis of patients presenting with AMI, comorbidities substantially influenced systemic concentrations of peak cTn. Comorbid illness is a significant predictor of mortality regardless of peak cTn levels and should be taken into consideration while interpr
AU  - Sundaram,V
AU  - Rothnie,K
AU  - Bloom,C
AU  - Zakeri,R
AU  - Sahadevan,J
AU  - Singh,A
AU  - Nagai,T
AU  - Potts,J
AU  - Wedzicha,J
AU  - Smeeth,L
AU  - Simon,D
AU  - Timmis,A
AU  - Rajagopalan,S
AU  - Quint,JK
DO  - 10.1136/heartjnl-2019-315844
EP  - 685
PY  - 2020///
SN  - 1355-6037
SP  - 677
TI  - Impact of comorbidities on peak troponin levels and mortality in acute myocardial infarction
T2  - Heart
UR  - http://dx.doi.org/10.1136/heartjnl-2019-315844
UR  - https://www.ncbi.nlm.nih.gov/pubmed/32102896
UR  - https://heart.bmj.com/content/106/9/677
UR  - http://hdl.handle.net/10044/1/77257
VL  - 106
ER  -

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