Maria Odqvist1, Per-Ola Andersson1, Hans Tygesen1, Kai M Eggers2, Martin J Holzmann3. 1. Department of Medicine, South Älvsborg Hospital, Borås, Sweden; Department of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. 2. Department of Medical Sciences, Uppsala University, Uppsala, Sweden. 3. Functional Area of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Internal Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. Electronic address: martin.holzmann@sll.se.
Abstract
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.
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.
Authors: Bryn E Mumma; Scott D Casey; Robert K Dang; Michelle K Polen; Jasmanpreet C Kaur; John Rodrigo; Daniel J Tancredi; Robert A Narverud; Ezra A Amsterdam; Nam Tran Journal: Ann Emerg Med Date: 2020-08-15 Impact factor: 5.721
Authors: Anoop S V Shah; Atul Anand; Fiona E Strachan; Amy V Ferry; Kuan Ken Lee; Andrew R Chapman; Dennis Sandeman; Catherine L Stables; Philip D Adamson; Jack P M Andrews; Mohamed S Anwar; John Hung; Alistair J Moss; Rachel O'Brien; Colin Berry; Iain Findlay; Simon Walker; Anne Cruickshank; Alan Reid; Alasdair Gray; Paul O Collinson; Fred S Apple; David A McAllister; Donogh Maguire; Keith A A Fox; David E Newby; Christopher Tuck; Ronald Harkess; Richard A Parker; Catriona Keerie; Christopher J Weir; Nicholas L Mills Journal: Lancet Date: 2018-08-28 Impact factor: 79.321
Authors: Rafel Cirer-Sastre; Alejandro Legaz-Arrese; Francisco Corbi; Isaac López-Laval; Jose Puente-Lanzarote; Vicenç Hernández-González; Joaquín Reverter-Masià Journal: Int J Environ Res Public Health Date: 2019-12-02 Impact factor: 3.390
Authors: Ziwei Lin; Swee Han Lim; Qai Ven Yap; Carol Hui Chen Tan; Yiong Huak Chan; Hung Chew Wong; E Shyong Tai; Arthur Mark Richards; Terrance Siang Jin Chua Journal: Int J Cardiol Heart Vasc Date: 2021-03-25