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Serum Troponin I levels and all cause mortality and incident myocardial infarction: analysis of the Pittsburgh veteran's healthcare system

Pappert-Outly, Tammy (2016) Serum Troponin I levels and all cause mortality and incident myocardial infarction: analysis of the Pittsburgh veteran's healthcare system. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Cardiovascular disease (CVD) is the leading cause of death in both men and women. Although rates of CVD have declined, the overall number of people who will develop CVD is substantial. Given current demographic trends and the future “silver tsunami”, the number of deaths due to CVD and incident CVD events will increase. Circulating levels of cardiac troponin have been shown to predict subsequent cardiac events. In addition, the predictive value of cardiac troponin I (cTnI) may extend beyond death and myocardial infarction. Most of the data come from observational studies of community dwelling subjects with relatively short follow-up period. It is important to systematically evaluate whether serum levels of cTnI predict CVD outcomes over the long term. In this dissertation, we evaluated a policy implemented at the Veteran’s Affair (VA) Healthcare System in Pittsburgh. This policy required that serum cTnI levels be drawn on all patients admitted to the hospital with pain between their ears and hips. After excluding patients who had an acute myocardial infarction or who died in the hospital, we identified 2901 patients with a serum cTnI level drawn in fiscal 2010. Follow-up continued for 365 days after their initial admission. Patients with elevated troponin I levels were more likely to die, odds ratio (OR)=2.31;95% confidence interval (CI), 1.52-3.52; to have a myocardial infarction, OR=5.46; 95% CI, 2.70-11.04; to develop heart failure OR=2.15;95% CI, 1.35-3.42; and left ventricular hypertrophy, OR=2.11; 95% CI, 1.18-3.77. The association with one year mortality was consistent in patients with and without acute coronary syndrome. We found no association with diabetes or hypertension. Serum cTn1 predicted chronic kidney disease in models that did not adjusted for baseline renal function, OR=2.06; 95% CI, 1.54-2.75. Given the public health importance of CVD, our results show the value in a single measure of troponin in predicting future CVD events over one year of follow-up.. Our results suggest that the Pittsburgh VA Health System should continue measuring troponin on these patients. Patients with elevated levels could be targeted for interventions aimed at preventing CVD events.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairCauley, Jane A.jcauley@edc.pitt.eduJCAULEY0000-0003-0752-4408
Committee MemberKuller, Lewis H.kullerl@edc.pitt.eduKULLERL
Committee MemberSekikawa, Akiraakira@pitt.eduAKIRA
Committee MemberYouk, Ada O.ayouk@pitt.eduAYOUK
Date: 20 June 2016
Date Type: Publication
Defense Date: 15 April 2016
Approval Date: 20 June 2016
Submission Date: 20 June 2016
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 73
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: DrPH - Doctor of Public Health
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Serum Troponin I, myocardial infarction, Pittsburgh Veteran's Healthcare System
Date Deposited: 20 Jun 2016 15:10
Last Modified: 15 Nov 2016 14:33


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