Wednesday, September 26, 2018

Non MI troponin elevations in patients 50 yo or younger


Background: While increased serum troponin levels are often due to myocardial infarction (MI), increased levels may also be found in a variety of other clinical scenarios. Although these causes of troponin elevation have been characterized in several studies in older adults, they have not been well characterized in younger individuals.

Methods: We conducted a retrospective review of patients 50 years of age or younger who presented to two large tertiary care centers between January 2000 and April 2016 with elevated serum troponin levels. Patients with prior known coronary artery disease (CAD) were excluded. The cause of troponin elevation was adjudicated via review of electronic medical records. All-cause death was determined using the Social Security Administration’s death master file.

Results: Of the 6081 cases meeting inclusion criteria, 3574 (58.8%) patients had an MI, while 2507 (41.2%) had a non-MI cause of troponin elevation. Over a median follow-up of 8.7 years, all-cause mortality was higher in patients with non-MI causes of troponin elevation compared with those with MI (adjusted HR: 1.32, 95% CI: 1.17-1.49, p less than 0.001). Specifically, mortality was higher in those with CNS pathologies (adjusted HR: 2.21, 95% CI: 1.86-2.62, p less than 0.001), non-ischemic cardiomyopathies (adjusted HR: 1.70, 95% CI: 1.40-2.06, p less than 0.001), and ESRD (adjusted HR: 1.36, 95% CI: 1.07-1.73, p=0.012). However, mortality was lower in patients with myocarditis compared with those with an acute MI (adjusted HR: 0.43, 95% CI: 0.31-0.60, p less than 0.001).

Conclusion: There is a broad differential for troponin elevation in young patients, which differs based on demographic features. Most non-MI causes of troponin elevation are associated with higher all-cause mortality compared with acute MI.

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