Elevated troponin predicts long-term adverse cardiovascular outcomes in hypertensive crisis: a retrospective study.
J Hypertens. 2012 Sep 15;
Authors: Pattanshetty DJ, Bhat PK, Aneja A, Pillai DP
BACKGROUND:: Hypertensive crisis is associated with poor clinical outcomes. Elevated troponin, frequently observed in hypertensive crisis, may be attributed to myocardial supply-demand mismatch or obstructive coronary artery disease (CAD). However, in patients presenting with hypertensive crisis and an elevated troponin, the prevalence of CAD and the long-term adverse cardiovascular outcomes are unknown. OBJECTIVE:: We sought to assess the impact of elevated troponin on cardiovascular outcomes and evaluate the role of troponin as a predictor of obstructive CAD in patients with hypertensive crisis. METHODS:: Patients who presented with hypertensive crisis (n?=?236) were screened retrospectively. Baseline and follow-up data including the event rates were obtained using electronic patient records. Those without an assay for cardiac Troponin I (cTnI) (n?=?65) were excluded. Of the remaining 171 patients, those with elevated cTnI (cTnI???0.12?ng/ml) (n?=?56) were compared with those with normal cTnI (cTnI?<?0.12?ng/ml) (n?=?115) at 2 years for the occurrence of major adverse cardiac or cerebrovascular events (MACCE) (composite of myocardial infarction, unstable angina, hypertensive crisis, pulmonary edema, stroke or transient ischemic attack). RESULTS:: At 2 years, MACCE occurred in 40 (71.4%) patients with elevated cTnI compared with 44 (38.3%) patients with normal cTnI [hazard ratio: 2.77; 95% confidence interval (CI): 1.79-4.27; P?<?0.001]. Also, patients with elevated cTnI were significantly more likely to have underlying obstructive CAD (odds ratio: 8.97; 95% CI: 1.4-55.9; P?<?0.01). CONCLUSION:: In patients with hypertensive crisis, elevated cTnI confers a significantly greater risk of long-term MACCE, and is a strong predictor of obstructive CAD.
PMID: 22990357 [PubMed - as supplied by publisher]