Does raised troponin during severe COPD exacerbation predict future cardiovascular events?

Résumé fourni par la source

Background: Patients with moderate or severe exacerbations of COPD (AECOPD) have increased subsequent cardiovascular (CV) event rates. AECOPD correlates with high serum troponin, impacting post-discharge mortality. Whether admission troponin predicts CV risk is less clear. Aims and objectives: Evaluate raised serum troponin at admission with AECOPD as a prognosticator for CV events (new AF, myocardial infarction (MI) or admission with CCF needing IV diuretics). Methods: This single-centre retrospective cohort study included all patients admitted to our UK District General Hospital in June-December 2022 with AECOPD and serum high sensitivity troponin I (hsTnI) measured on admission. We collected demographic, clinical and biochemical data. Primary outcome was association between admission hsTnI and CV event incidence at 12 months. Secondary endpoints included co-existing CV morbidity, time to first event and type of event. Results: Of 51 patients, 23 (45%) had elevated admission hsTnI. At 12 months, 9 (39%) patients with elevated hsTnI had suffered a CV event (RR 2.7 95% CI 1.0-7.8). Among the normal hsTnI group, 4 (14%) experienced CV events. 92% of first events occurred within three months (mean: 2.6 months). 19/25 events (76%) were CCF decompensations. 5/25 (20%) were MI. The raised hsTnI group demonstrated a greater proportion of CCF decompensations (75% vs 50%) as their first event. Pre-existing comorbidities included coronary artery disease (33%), diabetes (31%), AF (24%), and heart failure/cor pulmonale (24%). Conclusions: Our findings indicate raised admission troponin levels may predict for CV events following AECOPD. These patients may benefit from optimising cardiovascular medication.

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