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Published in: Internal and Emergency Medicine 3/2022

01-04-2022 | Acute Coronary Syndrome | IM - ORIGINAL

Poor outcome among patients undergoing myocardial perfusion imaging with intermediate-zone troponin

Authors: Anat Berkovitch, Alexey Naimushin, Nir Shlomo, Shlomi Matetzky, Roy Beigel, Michael Naroditsky, Elad Asher, Eli Rozen, Ilan Goldenberg, Robert Klempfner, Ronen Goldkorn

Published in: Internal and Emergency Medicine | Issue 3/2022

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Abstract

Background

Intermediate zone troponin elevation is defined as one to five times the upper limit of normal. Approximately half the patients presenting with chest pain to the emergency department have initial intermediate zone troponin.

Objectives

We aimed to investigate the long-term outcome of patients hospitalized with chest pain and intermediate zone troponin elevation.

Methods

We investigated 8269 patients hospitalized in a tertiary center with chest pain. All patients had serial measurements of troponin during hospitalization. Patients were divided into three groups based on their initial troponin levels: negative troponin (N = 6112), intermediate zone troponin (N = 1329) and positive troponin (N = 828). All patients underwent myocardial perfusion imaging (MPI) as part of the initial evaluation.

Results

Mean age of the study population was 68 ± 11, of whom 36% were women. Patients with an intermediate zone troponin were older, more likely to be males, and with significantly more cardiovascular co-morbidities. Multivariate analysis adjusted for age, gender, cardiovascular risk factors, and abnormal MPI result found that patients with intermediate zone troponin had a 70% increased risk of re-hospitalization at 1 year (HR 1.70, 95%CI 1.48–1.96, p-value < 0.001) and 5.3 times higher risk of total mortality at 1-year (HR 5.33, 95%CI 3.65–7.78, p-value < 0.001). sub-group analysis found that among the intermediate zone troponin group, patients with double intermediate zone troponin had the poorest outcome.

Conclusions

Intermediate zone troponin elevation is an independent risk factor associated with adverse outcomes and therefore patients with an initial value in this range should be closely monitored and aggressively managed.
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Metadata
Title
Poor outcome among patients undergoing myocardial perfusion imaging with intermediate-zone troponin
Authors
Anat Berkovitch
Alexey Naimushin
Nir Shlomo
Shlomi Matetzky
Roy Beigel
Michael Naroditsky
Elad Asher
Eli Rozen
Ilan Goldenberg
Robert Klempfner
Ronen Goldkorn
Publication date
01-04-2022
Publisher
Springer International Publishing
Published in
Internal and Emergency Medicine / Issue 3/2022
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-021-02668-1

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