Abstract
BackgroundThe prognostic ability of cardiac troponin I (TnI) has been demonstrated in general populations and among cardiovascular disease patients, but it has not been evaluated in cancer patients.HypothesisThis study assumes to have the prognostic ability of cardiac troponin in cancer patients visiting the emergency department.MethodsCancer patients visiting the emergency department were enrolled in this retrospective cohort study. Patients with previously known coronary artery disease or clinically indicated coronary angiography were not included. The maximal value from Siemens ADVIA Centaur troponin I Ultra assay within 24 hours was assessed. The primary endpoint was 180‐day all‐cause death, including cardiovascular and noncardiovascular death.ResultsA total of 9135 cancer patients (mean age: 63 years, male gender: 60%) were enrolled. Lowest (0.006 ng/mL), assay‐specific <99th % (0.007‐0.039 ng/mL), below median ≥ 99th % (0.040‐0.129 ng/mL), and above median ≥ 99th % (≥0.130 ng/mL) TnI were found in 4487 (49.1%), 3158 (34.6%), 852 (9.3%), and 638 (7.0%) patients, respectively. There was 3192 (34.9%) all‐cause deaths including 137 (1.5%) cardiovascular and 3047 (33.4%) noncardiovascular deaths in the 180‐day follow‐up period. The risks of all‐cause, cardiovascular, and noncardiovascular death increased across higher TnI strata (hazard ratio [HR] = 1.3‐2.9; 2.1‐9.3; 1.3‐1.8; P < .001, all). These findings were consistent within clinical subgroups including solid and hematologic cancers.ConclusionsCancer patients visiting the emergency department with elevated troponin I were at increased risk of 180‐day death. Cancer patients with elevated TnI may need additional evaluation or careful follow‐up even without cardiovascular disease diagnosis.
Highlights
Background Cardiac troponinI has been shown its prognostic ability in general population or cardiovascular disease but not yet in cancer patients
The risks of all-cause, cardiovascular, and non-cardiovascular death increased across higher troponin I Ultra assay (TnI) strata (hazard ratio (HR)=1.3 to 2.9; 2.1 to 9.3; 1.3 to 1.8; p
Cancer patients visiting emergency department with elevated troponin I were at increased risk of 180-day death
Summary
Background Cardiac troponinI has been shown its prognostic ability in general population or cardiovascular disease but not yet in cancer patients. Emergency physicians frequently need to quickly evaluate the clinical needs of the patients, stratify individual risk, determine optimal treatment, and decide admission or outpatient care setting with limited time and resource. This complexity sometimes is increased when patients present to the emergency department with few or no medical records. The pathophysiology of cardiac troponin elevation in non-ischemic cardiac or non-cardiac conditions are not fully elucidated, elevated cardiac troponin showed prognostic implication in acute coronary syndrome and in various clinical settings such as patients with non-diagnosed chest pain and even primary prevention study using statin.[4−8]
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