Does a Raised Serum Troponin During a Severe Chronic Obstructive Pulmonary Disease Exacerbation Predict Future Cardiovascular Events?

Background Cardiovascular (CV) complications are common in chronic obstructive pulmonary disease (COPD), particularly after acute exacerbations (AECOPD). Elevated cardiac biomarkers, such as high-sensitivity troponin I (hsTnI), indicate myocardial injury and commonly rise during AECOPD. While elevated serum troponin during severe AECOPD predicts mortality, the relationship between admission hsTnI levels and future CV event risk has not been investigated. Aims and objectives This study evaluated the prognostic value of admission serum troponin during severe AECOPD for future CV events, including new atrial fibrillation (AF), myocardial infarction (MI), or decompensated congestive cardiac failure (CCF) requiring intravenous diuretics. Methods This retrospective cohort study analyzed all patients admitted to a single center in 2022 with severe AECOPD and an admission hsTnI measurement. Patients were stratified by hsTnI levels (0-20ng/L and >20ng/L). The primary outcome was CV event incidence at 12 months, with secondary endpoints including event timing, type, and overall mortality. Results Patients with elevated hsTnI (n=37) had higher CV event incidence at 12 months compared to those with normal hsTnI (n=44) (24.3% vs 13.6%; OR 2.04, 95% CI 0.65-6.38). The hazard ratio (HR) for events was elevated but not statistically significant (HR 1.992, 95% CI 0.709-5.601, p=0.191). Raised hsTnI was associated with the greatest event risk at one month (OR 3.79 95% CI 0.38-38.1) and remained elevated over 12 months. Time to first event was also shorter in the elevated hsTnI group (3.0 vs 3.7 months, p=0.529). CCF was the most frequent CV event (77% of all events), followed by MI and AF.​ Elevated hsTnI was associated with 12-month mortality (56.8% vs 36.3%; OR 1.83, 95% CI 0.75-4.48), although the HR did not reach statistical significance (HR 1.767, 95% CI 0.922-3.388, p=0.086). Discussion These findings indicate that elevated admission hsTnI during severe AECOPD is associated with increased CV event incidence, earlier time-to-event, and greater mortality over 12 months. Retrospective study design and opportunistic screening limited the ability to infer causality and statistical significance. Selection bias may have influenced the results from the clinical decision-making to measure hsTnI.​ Larger prospective studies with multivariate regression analysis are required to confirm these findings and address confounders.​ Conclusions Our findings suggest that raised admission troponin levels are associated with CV events following severe AECOPD.  These patients may benefit from early CV risk assessment and preventative strategies.