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The Burden of Myocardial Injury: Unveiling Predictors of Mortality from Hospital to Long-Term Outcomes
Session:
SESSÃO DE POSTERS 46 - EPIDEMIOLOGIA PORTUGUESA NO FOCO
Speaker:
Matilde Ferreira
Congress:
CPC 2025
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.14 Cardiovascular Disease in Special Populations - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Matilde Ferreira; João Adriano Sousa; Débora Sá; Gonçalo Abreu; Francisco Sousa; Maria Isabel Mendonça; Sónia Freitas; Eva Henriques; Mariana Rodrigues; António Drumond; Ana Célia Sousa; Roberto Palma Dos Reis
Abstract
<p style="text-align:justify"><strong>Introduction: </strong>Myocardial injury(MI), defined as troponin elevation above the 99th percentile without acute myocardial ischemia, is common in emergency departments (EDs). Despite its prevalence, the risk profile, prognosis, and predictors of mortality in this population remain poorly explored in the literature.<br /> <strong>Aim:</strong> To assess MI-related mortality and its drivers up to a 6-year follow-up.<br /> <strong>Methods: </strong>We conducted a prospective registry of 250 patients admitted consecutively through the ED from January 1, 2018, onward, with high-sensitivity troponin T (hsTnT) levels above the 99th percentile. The assay used was Roche’s Elecsys Troponin T hsSTAT, with a 99th percentile cutoff of 14 ng/L. Patients with chronic kidney disease (ClCr<15 mL/min) were excluded, leaving 236 patients diagnosed with myocardial injury. Mortality was evaluated at 1 year and 6 years. Univariate analysis identified significant variables, followed by logistic regression to determine their independent predictive value for mortality.<br /> <strong>Results: </strong>Myocardial injury was far more prevalent than myocardial infarction (ratio 100:6.4), with 94% of patients classified as having MI (n=236). In-hospital mortality did not differ significantly between patients with hypertension, diabetes, dyslipidemia, or a higher number of traditional risk factors (p = n.s). Follow-up mortality was 5.6% (30 days), 31.3% (1year), and 75.4% (6 years).In-hospital mortality was significantly higher among patients diagnosed with respiratory infection (33% vs 61%, p = 0.017, OR 3.2)<br /> or acute/acute-on-chronic heart failure (31% vs 56%, p=0.03, OR 2.8). Elevated C-reactive protein (CRP; p < 0.001) and NT-proBNP levels (p=0.02) were also linked to<br /> higher in-hospital mortality. Logistic regression identified independent predictors of in-hospital mortality, including diminished oxygen supply (OR 3.6), length of hospital<br /> stay (OR 1.042), and CRP levels (OR 1.005). Cox regression identified troponin levels, age, diabetes, and obesity as independent predictors of 6-year mortality (HR 1.4, 1.1,<br /> 1.4, and 1.5, respectively; p<0.05).<br /> <strong>Conclusion:</strong>Myocardial injury appears to carry a worse prognosis than traditionally associated with myocardial infarction. Troponin levels are also significantly relevant to<br /> mortality in this population. Importantly, the drivers of in-hospital mortality differ from those affecting long-term outcomes. This study, one of the few of its kind, provides<br /> valuable insights into the characterization and risk stratification of patients with myocardial injury.</p>
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