Relationship between Troponin Elevation, Cardiovascular History and Adverse Events in Patients with acute exacerbation of COPD

Figures & data

Figure 1. Study flow-chart. COPD: chronic obstructive pulmonary disease. Tn: troponin. MI: myocardial infarction. AECOPD: acute exacerbation of COPD. IHD: ischemic heart disease. CVA: cerebrovascular accident.

Table 1.  Principal characteristics of study population stratified according to troponin status

	Negative Tn T (n = 210)	Positive Tn T (n = 484)	p
Age, (years)	77 ± 10	76 ± 10	0.6
Male sex, no. (%)	120 (57)	249 (52)	0.3
CV risk factors, no. (%)
Diabetes	45 (22)	127 (26)	0.4
Hypertension	105 (50)	271 (55)	0.2
Dyslipidemia	100 (48)	258 (53)	0.2
Current smokers	52 (24)	105 (22)	0.5
IHD history, no. (%)
Documented IHD	61 (29)	174 (36)	0.09
- prior MI	42 (20)	109 (22)	0.1
- prior PCI	55 (26)	147 (30)	0.4
- prior CABG	8 (4)	27 (5)	0.3
Laboratory,
WBC, (u/ml)	9.6 (7.3–12)	9.5 (7–13)	0.4
Haemoglobin, (g/dl)	13.2 ± 2	12.4 ± 2	<0.01
Platelets, (u/ml)	220 (174–270)	225 (175–275)	0.5
Fibrinogen (mg/dl)	415 (335–490)	430 (347–520)	0.5
Creatinine, (mg/ml)	1 ± 0.4	1.3 ± 0.7	<0.01
CRP, (mg/dl)	3 (1.4–12)	3.2 (1.5–12)	0.3
NT-proBNP, (pg/ml)	905 (288–1476)	990 (310–1531)	<0.01
Arterial blood gases,
pH	7.39 (7.35–7.4)	7.38 (7.33–7.4)	0.6
PaO2, (%)	68 (54–79)	66 (53–79)	0.4
PaCO2, (%)	47 (41–57)	49 (43–61)	0.5
TnT, (ng/L)
1st available	10 (10–10)	55 (30–60)	<0.01
2nd available	10 (8–10)	65 (35–70)	<0.01
3rd available	10 (6–10)	60 (35–70)	<0.01
Before hospital admission, no. (%)
Aspirin	111 (53)	269 (55)	0.5
Clopidogrel	12 (6)	32 (7)	0.8
β-blockers	58 (28)	145 (30)	0.6
Statins	130 (62)	311 (64)	0.6
ACE inhibitors	94 (45)	238 (49)	0.3
Before hospital admission, no. (%)
Aspirin	114 (54)	305 (63)	0.04
Clopidogrel	14 (7)	37 (8)	0.7
β-blockers	52 (25)	127 (26)	0.7
Statins	133 (63)	316 (65)	0.7
ACE inhibitors	98 (47)	252 (52)	0.2

Tn: troponin. CV: cardiovascular. IHD: ischemic heart disease. MI: myocardial infarction. PCI: percutaneous coronary intervention. CABG: coronary artery bypass graft. WBC: white blood cells. CRP: C-reactive protein. NT-proBNP: N terminal pro-brain natriuretic peptide. ACE: angiotensin converting enzyme.

Figure 2. Cumulative incidence of adverse events stratified according to Tn T elevation. Solid line: positive Tn T. Dotted line: negative Tn T. A: cumulative incidence of ­all-cause death. Tn: troponin. B: cumulative incidence of cardiac death and nonfatal MI. Tn: troponin. MI: myocardial infarction.

Table 2.  Adverse events of study population stratified according troponin status

	Negative Tn T (n = 210)	Positive Tn T (n = 484)	p
Adverse events, no. (%)
All-cause death	50 (24)	181 (37)	<0.01
Cardiac death	15 (7)	66 (14)	0.02
Nonfatal MI	4 (2)	29 (6)	0.03
CD and MI	19 (9)	83 (17)	<0.01
CVA	6 (3)	20 (4)	0.5
Heart failure	76 (36)	223 (46)	0.01

Tn: troponin I. CD: cardiac death. MI: myocardial infarction. CVA: cerebrovascular accident.

Figure 3. Cumulative incidence of adverse events stratified according to Tn T elevation and IHD history. Solid line: positive Tn T. Dotted line: negative Tn T. Thinner lines: patients with positive IHD history. Larger lines: patients with negative IHD history. A: cumulative incidence of all-cause death. Tn: troponin. IHD: ischemic heart disease. B: cumulative incidence of cardiac death and nonfatal MI. Tn: troponin. IHD: ischemic heart disease. MI: myocardial infarction.

Figure 4. Hazard risk of adverse events according to IHD history and troponin status. Subgroup analysis is shown with hazard ratios and 95% confidence intervals (CI) for adverse events (composite endpoint including cardiac death and nonfatal MI; all-cause death) among subgroups of patients (with IHD history vs. without IHD history) according troponin status (negative vs. positive). The probability value for interaction represents the likelihood of interaction between the variables. IHD: ischemic heart disease.