Observational studyBMJ (Clinical research ed.)2019
Association of troponin level and age with mortality in 250 000 patients: cohort study across five UK acute care centres.
Observational study in BMJ (Clinical research ed.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT03507309 (National Institute for Health Research), which is not on this map. Cited by 43 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
National Institute for Health Research (NIHR) Cardiovascular Health Informatics Collaborative
Who cites it
43 citing papers in PubMed.
- Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome: A cohort study.PLoS medicine · 2022Trial
- Maximum Troponin As an Independent Predictor of 30- and 90-day Mortality in Type 2 Myocardial Infarction.Critical pathways in cardiology · 2026Article
- Water hardness and digestive diseases: a large-scale population-based prospective cohort study.International journal of surgery (London, England) · 2026Article
- Characterizing the epidemiology ofEmerging microbes & infections · 2025Article
- The Prognostic Value of Cardiac Troponin in a Revascularized Cohort with First-Time Myocardial Infarction.Cardiology · 2025Article
- Unselected cardiac troponin testing and the diagnosis of myocardial infarction in the emergency department.BMC emergency medicine · 2025Article
- A proposed model using glycation metrics and circulating biomarkers for the prevention of cardiovascular disease.Frontiers in medicine · 2025Article
- Mortality Prediction of Biochemical Parameters in Patients Intubated in the Emergency Department.Cureus · 2024Article
- Phenogrouping heart failure with preserved or mildly reduced ejection fraction using electronic health record data.BMC cardiovascular disorders · 2024Article
- Prognostic significance of troponin in patients with malignancy (NIHR Health Informatics Collaborative TROP-MALIGNANCY study).Cardio-oncology (London, England) · 2024Article
- Diagnostic and prognostic value of an ejection fraction adjusted for myocardial remodeling.Frontiers in cardiovascular medicine · 2024Article
- Complications in Emergency Department Patients with Acute Coronary Syndrome with Contemporary Care.Cardiology · 2024Observational
- Changes in the investigation and management of suspected myocardial infarction and injury during COVID-19: a multi-centre study using routinely collected healthcare data.Frontiers in cardiovascular medicine · 2024Article
- Prehospital Targeting of 1-Year Mortality in Acute Chest Pain by Cardiac Biomarkers.Diagnostics (Basel, Switzerland) · 2023Article
- Impact of high-sensitivity troponin elevation and dynamic changes on 90-day mortality in patients with acute ischemic stroke after mechanical thrombectomy: results from an observational cohort.Journal of neurointerventional surgery · 2023Observational
- Diagnoses and Outcomes of Patients with Suspicion of Acute Coronary Syndrome and Raised High Sensitive Troponin I: A Single Center Study from Pakistan.Journal of laboratory physicians · 2023Article
- Inflammageing and Cardiovascular System: Focus on Cardiokines and Cardiac-Specific Biomarkers.International journal of molecular sciences · 2023Review
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- Article
- The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions.International journal of chronic obstructive pulmonary disease · 2023Article
Corrections and comments
- Erratum issued
Authors and funding
24 authors.
Funding
Abstract
objectiveTo determine the relation between age and troponin level and its prognostic implication.
designRetrospective cohort study.
settingFive cardiovascular centres in the UK National Institute for Health Research Health Informatics Collaborative (UK-NIHR HIC).
participants257 948 consecutive patients undergoing troponin testing for any clinical reason between 2010 and 2017.
main outcome measureAll cause mortality.
results257 948 patients had troponin measured during the study period. Analyses on troponin were performed using the peak troponin level, which was the highest troponin level measured during the patient's hospital stay. Troponin levels were standardised as a multiple of each laboratory's 99th centile of the upper limit of normal (ULN). During a median follow-up of 1198 days (interquartile range 514-1866 days), 55 850 (21.7%) deaths occurred. A positive troponin result (that is, higher than the upper limit of normal) signified a 3.2 higher mortality hazard (95% confidence interval 3.1 to 3.2) over three years. Mortality varied noticeably with age, with a hazard ratio of 10.6 (8.5 to 13.3) in 18-29 year olds and 1.5 (1.4 to 1.6) in those older than 90. A positive troponin result was associated with an approximately 15 percentage points higher absolute three year mortality across all age groups. The excess mortality with a positive troponin result was heavily concentrated in the first few weeks. Results were analysed using multivariable adjusted restricted cubic spline Cox regression. A direct relation was seen between troponin level and mortality in patients without acute coronary syndrome (ACS, n=120 049), whereas an inverted U shaped relation was found in patients with ACS (n=14 468), with a paradoxical decline in mortality at peak troponin levels >70×ULN. In the group with ACS, the inverted U shaped relation persisted after multivariable adjustment in those who were managed invasively; however, a direct positive relation was found between troponin level and mortality in patients managed non-invasively.
conclusionsA positive troponin result was associated with a clinically important increased mortality, regardless of age, even if the level was only slightly above normal. The excess mortality with a raised troponin was heavily concentrated in the first few weeks. STUDY REGISTRATION: ClinicalTrials.gov NCT03507309.
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