Outcomes of hospitalized patients with non-acute coronary syndrome and elevated cardiac troponin level

Edward O. McFalls, Greg Larsen, Gary R. Johnson, Fred S. Apple, Steven Goldman, Andrew Arai, Brahmajee K. Nallamothu, Robert Jesse, Scott T. Holmstrom, Patricia L. Sinnott

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objective: Cardiac troponin levels help risk-stratify patients presenting with an acute coronary syndrome. Although cardiac troponin levels may be elevated in patients presenting with non-acute coronary syndrome conditions, specific diagnoses and long-term outcomes within that cohort are unclear. Methods: By using the Veterans Affairs centralized databases, we identified all hospitalized patients in 2006 who had a troponin assay obtained during their initial reference hospitalization. On the basis of the diagnostic codes of the International Classification of Diseases, 9th Revision, primary diagnoses were categorized as acute coronary syndrome or non-acute coronary syndrome conditions. Results: Of a total of 21,668 patients with an elevated troponin level who were discharged from the hospital, 12,400 (57.2%) had a non-acute coronary syndrome condition. Among that cohort, the most common diagnostic category involved the cardiovascular system, and congestive heart failure (N = 1661) and chronic coronary artery disease (N = 1648) accounted for the major classifications. At 1 year after hospital discharge, mortality in patients with a non-acute coronary syndrome condition was 22.8% and was higher than in the acute coronary syndrome cohort (odds ratio 1.39; 95% confidence interval, 1.30-1.49). Despite the high prevalence of cardiovascular diseases in patients with a non-acute coronary syndrome diagnosis, use of cardiac imaging within 90 days of hospitalization was low compared with that in patients with acute coronary syndrome (odds ratio 0.25; 95% confidence interval, 0.23-0.27). Conclusions: Hospitalized patients with an elevated troponin level more often have a primary diagnosis that is not an acute coronary syndrome. Their long-term survival is poor and justifies novel diagnostic or therapeutic strategy-based studies to target the highest risk subsets before hospital discharge.

Original languageEnglish (US)
Pages (from-to)630-635
Number of pages6
JournalAmerican Journal of Medicine
Volume124
Issue number7
DOIs
StatePublished - Jul 2011
Externally publishedYes

Fingerprint

Troponin
Acute Coronary Syndrome
Hospitalization
Odds Ratio
Confidence Intervals
International Classification of Diseases
Veterans
Cardiovascular System
Hospital Mortality
Coronary Artery Disease
Cardiovascular Diseases
Heart Failure
Databases
Survival

Keywords

  • Cardiac imaging
  • Coronary artery disease
  • Non-acute coronary syndrome diagnosis
  • Outcomes
  • Troponins

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Outcomes of hospitalized patients with non-acute coronary syndrome and elevated cardiac troponin level. / McFalls, Edward O.; Larsen, Greg; Johnson, Gary R.; Apple, Fred S.; Goldman, Steven; Arai, Andrew; Nallamothu, Brahmajee K.; Jesse, Robert; Holmstrom, Scott T.; Sinnott, Patricia L.

In: American Journal of Medicine, Vol. 124, No. 7, 07.2011, p. 630-635.

Research output: Contribution to journalArticle

McFalls, EO, Larsen, G, Johnson, GR, Apple, FS, Goldman, S, Arai, A, Nallamothu, BK, Jesse, R, Holmstrom, ST & Sinnott, PL 2011, 'Outcomes of hospitalized patients with non-acute coronary syndrome and elevated cardiac troponin level', American Journal of Medicine, vol. 124, no. 7, pp. 630-635. https://doi.org/10.1016/j.amjmed.2011.02.024
McFalls, Edward O. ; Larsen, Greg ; Johnson, Gary R. ; Apple, Fred S. ; Goldman, Steven ; Arai, Andrew ; Nallamothu, Brahmajee K. ; Jesse, Robert ; Holmstrom, Scott T. ; Sinnott, Patricia L. / Outcomes of hospitalized patients with non-acute coronary syndrome and elevated cardiac troponin level. In: American Journal of Medicine. 2011 ; Vol. 124, No. 7. pp. 630-635.
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abstract = "Objective: Cardiac troponin levels help risk-stratify patients presenting with an acute coronary syndrome. Although cardiac troponin levels may be elevated in patients presenting with non-acute coronary syndrome conditions, specific diagnoses and long-term outcomes within that cohort are unclear. Methods: By using the Veterans Affairs centralized databases, we identified all hospitalized patients in 2006 who had a troponin assay obtained during their initial reference hospitalization. On the basis of the diagnostic codes of the International Classification of Diseases, 9th Revision, primary diagnoses were categorized as acute coronary syndrome or non-acute coronary syndrome conditions. Results: Of a total of 21,668 patients with an elevated troponin level who were discharged from the hospital, 12,400 (57.2{\%}) had a non-acute coronary syndrome condition. Among that cohort, the most common diagnostic category involved the cardiovascular system, and congestive heart failure (N = 1661) and chronic coronary artery disease (N = 1648) accounted for the major classifications. At 1 year after hospital discharge, mortality in patients with a non-acute coronary syndrome condition was 22.8{\%} and was higher than in the acute coronary syndrome cohort (odds ratio 1.39; 95{\%} confidence interval, 1.30-1.49). Despite the high prevalence of cardiovascular diseases in patients with a non-acute coronary syndrome diagnosis, use of cardiac imaging within 90 days of hospitalization was low compared with that in patients with acute coronary syndrome (odds ratio 0.25; 95{\%} confidence interval, 0.23-0.27). Conclusions: Hospitalized patients with an elevated troponin level more often have a primary diagnosis that is not an acute coronary syndrome. Their long-term survival is poor and justifies novel diagnostic or therapeutic strategy-based studies to target the highest risk subsets before hospital discharge.",
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AU - McFalls, Edward O.

AU - Larsen, Greg

AU - Johnson, Gary R.

AU - Apple, Fred S.

AU - Goldman, Steven

AU - Arai, Andrew

AU - Nallamothu, Brahmajee K.

AU - Jesse, Robert

AU - Holmstrom, Scott T.

AU - Sinnott, Patricia L.

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N2 - Objective: Cardiac troponin levels help risk-stratify patients presenting with an acute coronary syndrome. Although cardiac troponin levels may be elevated in patients presenting with non-acute coronary syndrome conditions, specific diagnoses and long-term outcomes within that cohort are unclear. Methods: By using the Veterans Affairs centralized databases, we identified all hospitalized patients in 2006 who had a troponin assay obtained during their initial reference hospitalization. On the basis of the diagnostic codes of the International Classification of Diseases, 9th Revision, primary diagnoses were categorized as acute coronary syndrome or non-acute coronary syndrome conditions. Results: Of a total of 21,668 patients with an elevated troponin level who were discharged from the hospital, 12,400 (57.2%) had a non-acute coronary syndrome condition. Among that cohort, the most common diagnostic category involved the cardiovascular system, and congestive heart failure (N = 1661) and chronic coronary artery disease (N = 1648) accounted for the major classifications. At 1 year after hospital discharge, mortality in patients with a non-acute coronary syndrome condition was 22.8% and was higher than in the acute coronary syndrome cohort (odds ratio 1.39; 95% confidence interval, 1.30-1.49). Despite the high prevalence of cardiovascular diseases in patients with a non-acute coronary syndrome diagnosis, use of cardiac imaging within 90 days of hospitalization was low compared with that in patients with acute coronary syndrome (odds ratio 0.25; 95% confidence interval, 0.23-0.27). Conclusions: Hospitalized patients with an elevated troponin level more often have a primary diagnosis that is not an acute coronary syndrome. Their long-term survival is poor and justifies novel diagnostic or therapeutic strategy-based studies to target the highest risk subsets before hospital discharge.

AB - Objective: Cardiac troponin levels help risk-stratify patients presenting with an acute coronary syndrome. Although cardiac troponin levels may be elevated in patients presenting with non-acute coronary syndrome conditions, specific diagnoses and long-term outcomes within that cohort are unclear. Methods: By using the Veterans Affairs centralized databases, we identified all hospitalized patients in 2006 who had a troponin assay obtained during their initial reference hospitalization. On the basis of the diagnostic codes of the International Classification of Diseases, 9th Revision, primary diagnoses were categorized as acute coronary syndrome or non-acute coronary syndrome conditions. Results: Of a total of 21,668 patients with an elevated troponin level who were discharged from the hospital, 12,400 (57.2%) had a non-acute coronary syndrome condition. Among that cohort, the most common diagnostic category involved the cardiovascular system, and congestive heart failure (N = 1661) and chronic coronary artery disease (N = 1648) accounted for the major classifications. At 1 year after hospital discharge, mortality in patients with a non-acute coronary syndrome condition was 22.8% and was higher than in the acute coronary syndrome cohort (odds ratio 1.39; 95% confidence interval, 1.30-1.49). Despite the high prevalence of cardiovascular diseases in patients with a non-acute coronary syndrome diagnosis, use of cardiac imaging within 90 days of hospitalization was low compared with that in patients with acute coronary syndrome (odds ratio 0.25; 95% confidence interval, 0.23-0.27). Conclusions: Hospitalized patients with an elevated troponin level more often have a primary diagnosis that is not an acute coronary syndrome. Their long-term survival is poor and justifies novel diagnostic or therapeutic strategy-based studies to target the highest risk subsets before hospital discharge.

KW - Cardiac imaging

KW - Coronary artery disease

KW - Non-acute coronary syndrome diagnosis

KW - Outcomes

KW - Troponins

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