Survival among hospital in-patients with troponin T elevation below levels defining myocardial infarction

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.