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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
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28. Risk Factors and Prevention
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32. Cardiovascular Nursing
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The paradox of myocardial injury and high-sensitive troponin assays: worst prognosis and burden than infarction?
Session:
CO - Prémio Jovem Investigador (Investigação Clínica)
Speaker:
Joao Adriano Sousa
Congress:
CPC 2019
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:
Comunicações Orais
FP Number:
---
Authors:
Joao Adriano Sousa; Joel Ponte Monteiro; Micaela Rodrigues Neto; Flávio Mendonça; M. Raquel Santos; Ricardo C. Rodrigues; Rita Ventura; José Alves; Graça Andrade; Sonia Freitas; Andreia Pereira; Décio Higino Da Silva Pereira; A. Drumond de Freitas
Abstract
<p>Introduction: Myocardial injury (Mi) as depicted in recent guidelines (2018), remains the elevation of troponin above the P99th, in the absence of acute myocardial ischemia. Often a common scenario in emergency departments (ED), its prevalence, risk profile and prognosis remain largely unexploited in the literature.</p> <p>Methods: Prospective registry of 250 patients admitted consecutively through the emergency department from the 1st of January 2018 onward, with a higher than P99th high-sensitive troponin assay. The kit used was Roche’s Elecsys TroponinT hsSTAT, and the P99th appointed by the manufacturer was 14 ng/L. All patients with chronic kidney disease ClCr<15ml/min, were excluded from the analysis. In-hospital and total mortality was evaluated at 3 time cutpoints (30, 180 and 335 days).</p> <p>Results: Myocardial injury (Mi) had a much higher occurence than myocardial infarction, MI (ratio 100:6.4). 94% of patients were classified has having Mi (n=236, 49.2% male, mean age of 75.83?3.3 years), 5.2% and 0.8% were classified has having type 1 and type 2 MI, respectively. Heart failure and chronic kidney disease were found in 34.7% and 28.4% of pts, respectively. hsTnT assays were requested in the ED because of dyspnea (49.4%), fatigue/prostration (14.3%), nausea or vomiting (12.4%), and chest pain (11.9%). 30% of Mi patients had a normal ECG. Cardiology intervention was requested in 32.2% of these patients, despite only 6.4% met criteria for coronary pathway. Among patients with “troponinitis”, the most common final diagnosis was respiratory infection (34.9%) and acute heart failure (32.8%). In-hospital mortality was 15.7%, 5% of which cardiovascular. Follow-up mortality was 5.6% (30 days), 25.6% (180 days) and 31.3% (335 days). In a subanalysis, a weak correlation between hsTnT levels and mortality was found, unlike traditionally known in MI patients. CKMB/CK ratio was significantly different in Mi and MI (0.07 vs 0.12, p<0.05).</p> <p>Conclusion: In our population, Mi was an important burden to the patient and the cardiologist, presenting a worst prognosis than MI. Our data may challenge current literature regarding the use of hsTnT assays instead of multiple cardiac biomarkers. To our knowledge, this is one of the few studies casting some light over the prognostic impact of myocardial injury and the current use of hsTnT assays in ED on a national level. Data may reflect a routine use of hsTnT assays in ED.</p>
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