impact of raised troponin in older patients in the presence or absence of coronary artery disease
2017
1. Abstract 1.1. Objective: Recent data has suggested an
increased risk for patients with raised troponin,but prognosis of older
patients with non-obstructive Coronary Artery Disease (CAD) is still unknown. 1.2. Methods : A retrospective cohort analysis was performed for all
in-patients with raised troponin T (January 2010 to December 2011, n=1351), 858
above the age of 65 were studied. Of these, 513 had angiography and they were
stratified according to their coronary arteries anatomy into older obstructive
CAD (≥ 50% stenosis) (OO- CAD, 448, 87.3%) and older non-obstructive
(<50% stenosis) (ONO-CAD, 65, 12.7%).
The 345 patients who had no angiography were followed separately for
their outcome. The
risk of death and Major Adverse Cardiac and Cerebrovascular Events (MACCE)
rates at one year, were calculated for the older groups who had angiography and
these were compared to the total patients who received angiograms for raised
troponin. 1.3. Results: The mean age was similar
between both older groups (77.9 ± 6.95 Vs.76.9 ± 7.02, P=0.236). The one-year MACCE rate
was similar in both the ONO-CAD and OO-CAD group (one-year MACCE: RR [95%
CI]=1.01[0.61-1.66], P=0.95). This was driven by the acute coronary syndrome
patients who had unplanned revascularization and stroke. The
one-year mortality was equal in ONO-CAD and OO-CAD group with a RR [95%
CI]=1.48[0.81-2.7], P=0.19. This was similar to the total patient groups
mortality at one- year with a RR [95% CI]= 0.93 [0.53-1.64], P=0.8. 1.4. Conclusion: Older patients with a raised
troponin and non-obstructive CAD are at equivalent MACCE & mortality risk
at one year to those with obstructive CAD.
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