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High-Sensitivity Troponins and Outcomes After Myocardial Infarction

Artikel i vetenskaplig tidskrift
Författare Maria Odqvist
Per-Ola Andersson
Hans Tygesen
K. M. Eggers
M. J. Holzmann
Publicerad i Journal of the American College of Cardiology
Volym 71
Nummer/häfte 23
Sidor 2616-2624
ISSN 0735-1097
Publiceringsår 2018
Publicerad vid Institutionen för medicin
Sidor 2616-2624
Språk en
Länkar https://doi.org/10.1016/j.jacc.2018...
Ämnesord biomarkers, coronary angiography, coronary artery disease, coronary revascularization, incidence, acute chest-pain, cardiac troponin, early-diagnosis, rule-out, impact, assays, prognosis, Cardiovascular System & Cardiology
Ämneskategorier Kardiovaskulär medicin

Sammanfattning

BACKGROUND It remains unknown how the introduction of high-sensitivity cardiac troponin T (hs-cTnT) has affected the incidence, prognosis, and use of coronary angiographies and revascularizations in patients with myocardial infarction (MI). OBJECTIVES The aim of this study was to investigate how the incidence of MI and prognosis after a first MI was affected by the introduction of hs-cTnT. METHODS In a cohort study, the authors included all patients with a first MI from the Swedish National Patient Registry from 2009 to 2013. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for risk of all-cause mortality, reinfarction, coronary angiographies, and revascularizations in patients with MI diagnosed using hs-cTnT compared with those diagnosed using conventional troponins (cTn). RESULTS During the study period, 47,133 MIs were diagnosed using cTn and 40,746 using hs-cTnT. The rate of MI increased by 5% (95% CI: 0% to 10%) after the introduction of hs-cTnT. During 3.9 +/- 2.8 years of follow-up, there were 33,492 deaths, with no difference in the risk of all-cause mortality (adjusted HR: 1.00; 95% CI: 0.97 to 1.02). There were, in total, 15,766 reinfarctions during 3.1 +/- 2.3 years of follow-up, with the risk of reinfarction reduced by 11% in patients diagnosed using hs-cTnT (adjusted HR: 0.89; 95% CI: 0.86 to 0.91). The use of coronary angiographies (adjusted HR: 1.16; 95% CI: 1.14 to 1.18) and revascularizations (adjusted HR: 1.13; 95% CI: 1.11 to 1.15) increased in the hs-cTnT group. CONCLUSIONS In a nationwide cohort study including 87,879 patients with a first MI, the introduction of hs-cTnT was associated with an increased incidence of MI, although with no impact on survival. We also found a reduced risk of reinfarction alongside increased use of coronary angiographies and revascularizations. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

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Utskriftsdatum: 2020-05-29