title: Prognostic Impact of Myocardial Injury Related to Various Cardiac and Noncardiac Conditions.
abstract: Elevated cardiac troponins in clinical conditions other than myocardial infarction are well known. For such occurrences, the term "myocardial injury" has been proposed. The long-term outcome in patients with myocardial injury related to various cardiac and noncardiac clinical disorders is unknown.
  
  
  
  During January 2010 to January 2011, we prospectively studied hospitalized patients who had cardiac troponin I measured on clinical indication. Patients with cardiac troponin I values >30 ng/L and no evidence of myocardial ischemia were diagnosed as having myocardial injury. Patients were classified into 5 categories of plausible related conditions: cardiac ischemic, cardiac nonischemic, noncardiac, multifactorial, or indeterminate. Follow-up was a minimum of 3 years, with all-cause mortality as the single end-point.
  
  
  
  A total of 3762 patients were considered, of whom 1089 (29%) had myocardial injury. The most common associated conditions were noncardiac (n = 346) or multifactorial (n = 359). Cardiac ischemic (n = 183) and cardiac nonischemic (n = 134) conditions occurred less frequently. After a median of 3.2 years, 645 patients (59%) had died. A multivariate Cox regression analysis showed no difference in mortality between patients with cardiac ischemic and cardiac nonischemic conditions (hazard ratio [HR] 0.75; 95% confidence interval [CI], 0.50-1.13; P = .2). Patients with noncardiac or multifactorial disorders, however, had significantly higher mortality than those with associated cardiac ischemic conditions (HR 1.39; 95% CI, 1.06-1.80; P = .02, and HR 1.94; 95% CI, 1.50-2.51; P <.001), respectively.
  
  
  
  In patients with myocardial injury, the most common associated conditions were noncardiac or multifactorial. Of notice, these patients had significantly higher long-term mortality when compared with those with associated cardiac conditions.
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Laura
authors.initials: L
authors.lastname: Sarkisian
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Lotte
authors.initials: L
authors.lastname: Saaby
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Tina S
authors.initials: TS
authors.lastname: Poulsen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Oke
authors.initials: O
authors.lastname: Gerke
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Susanne
authors.initials: S
authors.lastname: Hosbond
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Nikolaj
authors.initials: N
authors.lastname: Jangaard
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Axel C P
authors.initials: AC
authors.lastname: Diederichsen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Thygesen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: Hans.Mickley@rsyd.dk.
authors.forename: Hans
authors.initials: H
authors.lastname: Mickley
mesh_terms: D015415:Biomarkers / Q000097:blood; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006335:Heart Injuries / Q000097:blood* / Q000401:mortality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Myocardial injury; Prognosis; Troponins