Causas de troponinas cardíacas elevadas en Urgencias y su mortalidad asociada

por | junio 26, 2016

Un abstract de un artículo a publicarse en Academic Emergency Medicine, sobre la significancia de las troponinas elevadas en el Servicio de Emergencia (Urgencias).

Los autores concluyen que aproximadamente el 75% de todos los pacientes con troponinas cardíacas elevadas en Urgencias no tienen infarto miocárdico tipo 1. Sin embargo la mortalidad de los pacientes sin IM tipo 1 es similar a la de los pacientes con IM tipo 1.

Analizando e n profundidad, me parece que hay un sesgo, porque en el grupo non-T1MI tambien hay MI, es decir, infartos miocárdicos agudos, pero de los de tipo 2. Un 35% que pesan mucho y por ello la mortalidad es similar. Es verdad que también hay un 35% de elevación de trapo niña de causa “multifactorial”, pero es que más de un tercio de los pacientes con troponina I elevada tienen un IM tipo 2.

Acad Emerg Med. 2016 Jun 20. doi: 10.1111/acem.13033. [Epub ahead of print] Causes of elevated cardiac troponins in the emergency department and their associated mortality.
Meigher S, Thode HC, Peacock WF, Bock JL, Gruberg L4, Singer AJ.
Author information
Cardiac troponins (cTn) are structural components of myocardial cells and are expressed almost exclusively in the heart. Elevated cTn levels indicate myocardial cell damage/death but not reflect the underlying etiology. The 3rd Universal Definition of myocardial infarction (MI) differentiates MI into various types. Type 1 (T1MI) is due to plaque rupture with thrombus, while type 2 (T2MI) is a result of a supply: demand mismatch. Non-MI cTn elevations are also common. We determined the causes of elevated cTn in a tertiary care ED and the associated in-hospital mortality.
We performed a structured, retrospective review of all consecutive adult ED patients with elevated troponin I (defined as >99th %ile of the normal population, as run on the ADVIA Centaur® platform; Siemens USA, Malvern, PA) during 1 year. Causes of elevated cTn were classified based on the 3rd Universal Definitions. Comparisons between groups were performed using Χ2 and Mann-Whitney U tests.
Of 96,612 ED patients presenting from 5/12-4/13, 13,502 (14%) had cTn measured, of which 1,310 (9.7%) were elevated. Of these, 340 (26.5%, 95% CI, 24.2-29.0) were T1MI, 452 (35.2%, 95% CI, 32.7-37.9) T2MI, 458 (35.7%, 95% CI, 33.1-38.4) multifactorial and 33 (2.5%, 95% CI, 1.8-3.5) due to non-ischemic injury. Non-T1MI patients were slightly older, more likely female, and had higher BUN and creatinine. Comorbidities were more common in non-T1MI while cardiac risk factors were more common in T1MI. Non-T1MI patients were less likely to have diagnostic ECGs and had lower initial and subsequent cTn levels. In hospital mortality rates were similarly high for T1MI and non-T1MI (11% [95% CI 8-15%] vs. 10% [95% CI 8-12%], P=0.48).
Of all ED patients with elevated cTn, ~75% have a non-T1MI. The mortality of patients with non-T1MI is similar to the mortality in patients with T1MI. This article is protected by copyright. All rights reserved.