Effects of comorbidity and hospital care on 6-month mortality in patients with elevated cardiac troponin T.

OBJECTIVE: To examine the effects of comorbidity and hospital care on mortality in patients with elevated cardiac troponin T. DESIGN: Observational study. SETTING: A large university hospital with on-site diagnostic cardiac catheter laboratory. PATIENTS: All hospitalised patients with elevated cardiac troponin T level (> or =0.01 microg/l) over an 8-week period. MAIN OUTCOME MEASURES: 6-month all-cause mortality. RESULTS: Among 313 patients with elevated cardiac troponin T, 195 had acute coronary syndrome and 118 had other conditions. Multivariate analysis showed that among patients with acute coronary syndrome, increasing comorbidity score (odds ratio (OR) 1.23 per point increase, 95% confidence interval (CI) 1.00 to 1.51; p = 0.048), age (OR 1.08 per year, 95% CI 1.04 to 1.13; p<0.001), raised troponin T level (OR 2.22 per 10-fold increase, 95% CI 1.27 to 3.89; p = 0.005), and ST depression (OR 3.12, 95% CI 1.38 to 7.03; p = 0.006) were independent adverse predictors, while cardiologist care (OR 0.22, 95% CI 0.09 to 0.51; p<0.001) was associated with a better survival. Increasing troponin T level (OR 3.33 per 10-fold increase, 95% CI 1.24 to 8.91; p = 0.017) was found to predict a worse prognosis among patients without acute coronary syndrome, and cardiologist care did not affect outcome in this group. Among hospital survivors with acute coronary syndrome, increasing comorbidity score, age and a lack of cardiologist care were independently associated with lesser use of effective medications. CONCLUSIONS: Comorbidity was associated with a higher 6-month mortality in patients having acute coronary syndrome, and lesser use of effective medicines among hospital survivors. Cardiologist care was associated with better 6-month survival in patients with acute coronary syndrome, but not in those without acute coronary syndrome.

Raised cardiac troponin T levels in patients without acute coronary syndrome.

OBJECTIVE: To investigate the frequency, diagnosis and outcome of patients admitted to hospital with acute coronary syndrome (ACS) or other conditions associated with raised levels of cardiac troponin T. DESIGN: Observational study. SETTING: A large university hospital. PATIENTS: Consecutive patients admitted over an 8-week period who had a serum troponin T test as part of their clinical assessment were included. Patients were separated into those with raised (> or =0.01 microg/l) or normal (<0.01 microg/l) troponin T levels, and further categorised into those with or without a diagnosis of ACS. MAIN OUTCOME MEASURES: In-hospital mortality in all patients; and 6-month hospital re-admissions and all-cause mortality in patients without or with ACS and raised levels of troponin T. RESULTS: Of 1021 patients, 118 patients had no ACS but raised troponin T levels, 195 had ACS with raised troponin T, 80 had ACS with normal troponin T and 628 had no ACS with normal troponin T. Their in-hospital all-cause mortalities were 36%, 18%, 0% and 3%, respectively (p<0.001, highest mortality v other groups). 6-month all-cause mortality remained higher in patients without ACS and with raised levels of troponin T than in those with ACS and raised troponin T (42% v 29%; p = 0.020). CONCLUSIONS: Patients without ACS but with raised levels of troponin T comprised 38% of all hospitalised patients found to have raised troponin T. These patients had worse in-hospital and 6-month outcome than those having ACS with raised levels of troponin T.