Abstract
Introduction: Troponin I (TnI) is a principal biomarker in diagnosing acute myocardial infarction (AMI). However, large numbers of hospitalized patients are tested for TnI in whom AMI is unlikely or not expected. Hypothesis: We hypothesized the baseline comorbidities of those undergoing troponin testing differ from those not tested and that troponin testing is associated with outcomes. Methods: In total, 54,039 inpatient admissions from a 9-hospital system in Texas were reviewed over a 24-month period (2017-2018). Data were collected on primary international classification of disease (ICD-10) diagnoses, TnI, risk factors, and death during hospitalization or readmission within 30 days. Odds ratios were calculated for all patients adjusted for demographic differences in the population. Bivariate analysis was performed on the baseline risk factors for both troponin testing and troponin positivity. Results: TnI testing occurred in 30,173/54,039 (55.8%) individual hospital admissions. Of those, 19.9% had at least one elevated TnI value >99th% (0.1 ng/ml). Tested patients were older (70.1 [IQR 59.5, 80.9] vs 63.7 [IQR 53.4, 73.1] years), more likely to be male (14,497/30,173 (48.1%) vs 10,845/23,866 (45.4%)) and had a greater burden of cardiovascular disease and risk factors including: gender, race, smoking, hypertension, hyperlipidemia, type 2 diabetes mellitus, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, prior cerebrovascular accident, and prior AMI. Troponin testing was associated with death during hospitalization (OR 3.11, 95% CI 2.63, 3.71, p<0.0001), and an elevated troponin was found to be associated with mortality (OR 4.06, 95% CI 3.49, 4.72, p<0.0001). Conclusions: Troponin testing is associated with death during index hospitalization. Troponin values >99th% were associated only with increased mortality. This data suggest that selection plays a role in identifying patients at risk for in-hospital death.
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