Troponin Level at Presentation as a Prognostic Factor Among Patients Presenting with non-ST Segment Elevation Myocardial Infarction

Abstract

Abstract Introduction Timely reperfusion within 120 minutes is strongly recommended in patients presenting with non-ST segment myocardial infarction (NSTEMI) with very high-risk features. Evidence regarding the use of high sensitivity cardiac troponin (hs-cTn) concentration upon admission for the risk-stratification of patients presenting with NSTEMI in order to expedite percutaneous coronary intervention (PCI) and thus potentially improve outcomes is limited. Methods All patients admitted to a tertiary care center intensive cardiac care unit (ICCU) between July 2019 – July 2022 were included and were followed for up to 3 years. Hs-cTnI level on presentation was recorded and patients were divided into four quartiles according to their hs-cTnI level on admission. Association between the initial hs-cTnI level and all-cause mortality during the follow-up period was examined. Results A total of 544 NSTEMI patients with a median age of 67 were included. There was no difference between the initial hs-cTnI level groups regarding age and comorbidities. A higher mortality rate was observed in the highest hs-cTnI quartile as compared with the lowest hs-cTnI quartile (16.2% vs. 7.35%, p=0.03) with Hazard ratio (HR) for mortality of 2.6 (CI: 1.23-5.4; p=0.012). Conclusions Patients presenting with NSTEMI and higher Hs-cTnI levels on admission were at higher risk for mortality during follow-up. This finding supports further prospective studies to examine the impact of early reperfusion strategy on mortality in patients presenting with NSTEMI according to degree of troponin elevation on admission.