Background Cardiac troponin I has been shown its prognostic ability in general population or cardiovascular disease but not yet in cancer patients. This study aimed to investigate the prognostic implication of cardiac troponin in cancer patients visiting emergency department.
Methods In this retrospective cohort study, cancer patients visiting emergency department were enrolled. Patients with previously known coronary artery disease or clinically indicated coronary angiography were not included. The maximal value of Siemens ADVIA Centaur troponin I Ultra assay (TnI) within 24 hour were assessed. Primary endpoint was 180-day all-cause death that included cardiovascular and non-cardiovascular death.
Results A total of 9,135 patients (mean age 63 year, male gender 60%) were enrolled. The lowest (0.006 ng/ml), assay-specific <99 percentile (0.007-0.039 ng/ml), below median of ≥99 percentile (0.040-0.129 ng/ml), and above median of ≥99 percentile (≥0.130 ng/ml) TnI were found in 4,487 (49.1%), 3,158 (34.6%), 852 (9.3%), and 638 (7.0%) patients. There was 3,192 (34.9%) all-cause death including 137 (1.5%) cardiovascular and 3,047 (33.4%) non-cardiovascular death in the 180-day follow-up period. The risks of all-cause, cardiovascular, and non-cardiovascular death increased across higher TnI strata (hazard ratio (HR)=1.3 to 2.9; 2.1 to 9.3; 1.3 to 1.8; p<0.001, all). These findings were consistent in clinical subgroups including solid and hematologic cancer.
Conclusions Cancer patients visiting emergency department with elevated troponin I were at increased risk of 180-day death. Cancer patients with elevated TnI may need additional evaluation or careful follow-up even without diagnosis of cardiovascular disease.