Utilidad de la determinación de troponina cardíaca para la predicción de mortalidad y eventos Cardiovasculares en pacientes atendidos en los

Identificador:  TDX:3112

Handle: https://hdl.handle.net/20.500.11797/TDX3112

Autors:  González Del Hoyo, Maria Isabel

Resum:
Cardiac troponin is a specific marker of myocardial injury and its elevation is associated with an adverse prognosis in patients with acute coronary syndrome. It has been hypothesized that in patients without a coronary event, it may also determine an increased risk of cardiovascular events. The objective of this doctoral thesis was to evaluate the ability of cardiac troponin to predict risk for adverse outcomes in patients presenting with different clinical scenarios to the emergency department. This doctoral thesis is a composite of four retrospective cohort studies, analyzing patients attending the emergency department of the Hospital Universitari Joan XXIII and undergoing troponin testing. The first study evaluated 3.629 patients with absence or presence of chest pain and with or without troponin elevation. The second study described the diagnoses adjudicated to the troponin elevation in the discharge reports of 659 patients with positive troponin not diagnosed with an acute coronary syndrome. The third study analyzed 222 subjects with a primary diagnosis of tachyarrhythmia in the presence or absence of troponin elevation. The fourth study compared the predictive ability for mortality of troponin and the CHA2DS2-VASc score, in 578 patients with atrial fibrillation. The results revealed that troponin elevation is frequent and associated with an increased risk of death in those without chest pain, without acute coronary syndrome, with tachyarrhythmias and with atrial fibrillation, attributable to an increased cardiovascular risk profile and a higher burden of comorbidities. In patients with atrial fibrillation, troponin elevation has an incremental prognostic value over the CHA2DS2-VASc score with regard to mortality. Finally, the discharge reports review reflects a lack of diagnoses related to troponin elevation. These analyses thus, confirm the need to develop and implement prevention programs for patients presenting at the emergency department with cardiac troponin elevation, regarding its role as an adverse prognostic factor.