Comparison of Troponin Elevation, Prior Myocardial Infarction, and Chest Pain in Acute Ischemic Heart Failure
Bibliographic record
Abstract
Background Patients with heart failure (HF) with concomitant ischemic heart disease (IHD) have not been well characterized. We examined survival of patients with ischemic HF syndrome (IHFS), defined as presentation with acute HF and concomitant features suggestive of IHD. Methods Patients were included if they presented with acute HF to hospitals in Ontario, Canada. IHD was defined by any of the following criteria: angina/chest pain, prior myocardial infarction (MI), or troponin elevation that was above the upper limit of normal (mild) or suggestive of cardiac injury. Deaths were determined after hospital presentation. Results Of 5353 patients presenting with acute HF, 4088 (76.4%) exhibited features of IHFS. Patients with IHFS demonstrated a higher rate of 30-day (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.33-2.68) and 1-year death (HR, 1.16, 95% CI, 1.00-1.35) compared with those with nonischemic HF. Troponin elevation demonstrated the strongest association with mortality. Mildly elevated troponin was associated with increased hazard over 30-day (HR, 1.77; 95% CI, 1.12-2.81) and 1-year (HR, 1.63; 95% CI, 1.38-1.93) mortality. Troponins indicative of cardiac injury were associated with increased hazard of death over 30 days (HR, 2.33; 95% CI, 1.63-3.33) and 1 year (HR, 1.40; 95% CI, 1.21-1.61). The association between elevated troponin and higher mortality at 30 days was similar in left ventricular ejection fraction subcategories of HF with reduced ejection fraction, HF with mildly reduced ejection fraction, or HF with preserved ejection fraction (P interaction = 0.588). After multivariable adjustment, prior MI and angina were not associated with higher mortality risk. Conclusions In acute HF, elevated troponin, but not prior MI or angina, was associated with a higher risk of 30-day and 1-year mortality irrespective of left ventricular ejection fraction. Resume Contexte Les patients presentant une insuffisance cardiaque et une cardiopathie ischemique (CI) concomitante ne sont pas bien caracterises. Nous avons examine les donnees sur la survie de patients atteints d’un syndrome d’insuffisance cardiaque ischemique (SICI), caracterise par la presence d’une insuffisance cardiaque aigue et de manifestations concomitantes evoquant une CI. Methodologie Les donnees examinees concernaient des patients atteints d’insuffisance cardiaque aigue recus en consultation dans des hopitaux de l’Ontario, au Canada. Un patient etait repute atteint de CI s’il repondait a l’un des criteres suivants : angine/douleur thoracique, antecedents d’infarctus du myocarde (IM) ou elevation de la concentration de troponine se situant au-dela de la limite superieure de la normale (cas leger) ou evoquant une lesion cardiaque. La determination des deces a ete effectuee en aval des consultations hospitalieres. Resultats Parmi 5 353 patients atteints d’insuffisance cardiaque aigue recus en consultation, 4 088 (76,4 %) presentaient des caracteristiques de SICI. Chez les patients atteints d’un SICI, un taux plus eleve de mortalite a 30 jours (rapport des risques instantanes [RRI] : 1,89, intervalle de confiance [IC] a 95 % : 1,33-2,68) et a 1 an (RRI : 1,16, IC a 95 % : 1,00-1,35) a ete note comparativement aux patients atteints d’insuffisance cardiaque non ischemique. L’elevation de la concentration de troponine presentait la plus forte association avec la mortalite. Une legere elevation de la concentration de troponine se trouvait associee a un risque accru de mortalite a 30 jours (RRI : 1,77, IC a 95 % : 1,12-2,81) et a 1 an (RRI : 1,63, IC a 95 % : 1,38-1,93). Les concentrations de troponine temoignant de lesions cardiaques etaient associees a une augmentation du risque de mortalite a 30 jours (RRI : 2,33, IC a 95 % : 1,63-3,33) et a 1 an (RRI : 1,40, IC a 95 % : 1,21-1,61). L’association entre une concentration elevee de troponine et une augmentation du taux de mortalite a 30 jours etait semblable dans les sous-categories d’insuffisance cardiaque avec fraction d’ejection ventriculaire gauche reduite, legerement reduite ou preservee (p = 0,588 pour l’interaction). Apres correction multivariee, les antecedents d’IM et d’angine n’etaient pas associes a un risque accru de mortalite. Conclusions Dans un contexte d’insuffisance cardiaque aigue, l’elevation de la concentration de troponine etait associee a un risque plus eleve de mortalite a 30 jours et a 1 an independamment de la fraction d’ejection ventriculaire gauche; les antecedents d’IM ou d’angine ne l’etaient toutefois pas.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".