Clinical Determinants of Myocardial Injury, Detectable and Serial Troponin Levels among Patients with Hypertensive Crisis
| Autor: | Affan Irfan, George Augustine Koromia, Ahmed Amro, Giancarlo Acosta, Niharika Bhardwaj, Mark Studeny, Waiel Abusnina, Rodrigo Aguilar |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
obesity
medicine.medical_specialty hypertension Population Cardiology body mass index macromolecular substances 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine hypertensive crisis Internal medicine Internal Medicine Medicine myocardial injury Hypertensive emergency Myocardial infarction education education.field_of_study biology troponin business.industry Hypertensive urgency General Engineering Retrospective cohort study medicine.disease Troponin hypertensive emergency myocardial infarction Emergency Medicine hypertensive urgency biology.protein business Body mass index 030217 neurology & neurosurgery Obesity paradox |
| Zdroj: | Cureus |
| ISSN: | 2168-8184 |
| Popis: | Introduction There is a high prevalence of hypertensive crisis with myocardial injury, as evidenced by elevation in cardiac troponin levels. The risk factors predisposing patients to developing a myocardial injury, detectable troponin, and increase in serial troponin in this population are not known. Methods A retrospective study was designed to include all patients, presenting to the emergency room, diagnosed with hypertensive crisis, using International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes between 2016-2018 (n=467). Logistic regression was used to determine the important predictors of myocardial injury evidenced by troponin elevation >99th percentile of upper reference level (URL), detectable troponin (> 0.015 ng/ml), and increase in serial troponin levels. Results The 99th percentile of the initial troponin level among all patients was 0.433 ng/ml. A total of 15% had a myocardial injury, and the significant risk factors associated with it were body mass index (BMI) < 30 kg/m2 (odds ratio [OR] 0.50, confidence interval [CI] 0.28-0.89), congestive heart failure (CHF; OR 4.28, CI 2.21-8.25) and prior use of aspirin (OR 1.98, CI 1.08-3.63). About 35% had detectable troponin, and BMI < 30 kg/m2 (OR 0.62, CI 0.40-0.97), CHF (OR 3.49, CI 2.06-5.9), elevated creatinine (OR 1.17, CI 1.02-1.34) and age 99th percentile URL, and the majority of these patients have minimal changes in serial troponin. Low BMI was associated with higher initial and serial troponin levels, and this obesity paradox was stronger among females and older patients. |
| Databáze: | OpenAIRE |
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