The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions

Constantinos Kallis; Amit Kaura; Nathan A Samuel; Abdulrahim Mulla; Ben Glampson; Kevin O'Gallagher; Jim Davies; Dimitri Papadimitriou; Kerrie J Woods; Anoop D Shah; Bryan Williams; Folkert W Asselbergs; Erik K Mayer; Richard W Lee; Christopher Herbert; Stuart W Grant; Nick Curzen; Iain B Squire; Thomas Johnson; Ajay M Shah; Divaka Perera; Rajesh K Kharbanda; Riyaz S Patel; Keith M Channon; Jamil Mayet; Jennifer K Quint

doi:10.2147/COPD.S432166

The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions

Constantinos Kallis, Amit Kaura, Nathan A Samuel, Abdulrahim Mulla, Ben Glampson, Kevin O'Gallagher, Jim Davies, Dimitri Papadimitriou, Kerrie J Woods, Anoop D Shah, Bryan Williams, Folkert W Asselbergs, Erik K Mayer, Richard W Lee, Christopher Herbert, Stuart W Grant, Nick Curzen, Iain B Squire, Thomas Johnson, Ajay M ShahDivaka Perera, Rajesh K Kharbanda, Riyaz S Patel, Keith M Channon, Jamil Mayet, Jennifer K Quint^*

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

3 Citations (Scopus)

Abstract

BACKGROUND: No single biomarker currently risk stratifies chronic obstructive pulmonary disease (COPD) patients at the time of an exacerbation, though previous studies have suggested that patients with elevated troponin at exacerbation have worse outcomes. This study evaluated the relationship between peak cardiac troponin and subsequent major adverse cardiac events (MACE) including all-cause mortality and COPD hospital readmission, among patients admitted with COPD exacerbation.

METHODS: Data from five cross-regional hospitals in England were analysed using the National Institute of Health Research Health Informatics Collaborative (NIHR-HIC) acute coronary syndrome database (2008-2017). People hospitalised with a COPD exacerbation were included, and peak troponin levels were standardised relative to the 99th percentile (upper limit of normal). We used Cox Proportional Hazard models adjusting for age, sex, laboratory results and clinical risk factors, and implemented logarithmic transformation (base-10 logarithm). The primary outcome was risk of MACE within 90 days from peak troponin measurement. Secondary outcome was risk of COPD readmission within 90 days from peak troponin measurement.

RESULTS: There were 2487 patients included. Of these, 377 (15.2%) patients had a MACE event and 203 (8.2%) were readmitted within 90 days from peak troponin measurement. A total of 1107 (44.5%) patients had an elevated troponin level. Of 1107 patients with elevated troponin at exacerbation, 256 (22.8%) had a MACE event and 101 (9.0%) a COPD readmission within 90 days from peak troponin measurement. Patients with troponin above the upper limit of normal had a higher risk of MACE (adjusted HR 2.20, 95% CI 1.75-2.77) and COPD hospital readmission (adjusted HR 1.37, 95% CI 1.02-1.83) when compared with patients without elevated troponin.

CONCLUSION: An elevated troponin level at the time of COPD exacerbation may be a useful tool for predicting MACE in COPD patients. The relationship between degree of troponin elevation and risk of future events is complex and requires further investigation.

Original language	English
Pages (from-to)	2405-2416
Number of pages	12
Journal	International journal of chronic obstructive pulmonary disease
Volume	18
DOIs	https://doi.org/10.2147/COPD.S432166
Publication status	Published - 6 Nov 2023

Bibliographical note

Publisher Copyright:
© 2023 Kallis et al.

Keywords

Humans
Pulmonary Disease, Chronic Obstructive
Patient Readmission
Hospitalization
Troponin
Cardiovascular Diseases/etiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Kallis, C., Kaura, A., Samuel, N. A., Mulla, A., Glampson, B., O'Gallagher, K., Davies, J., Papadimitriou, D., Woods, K. J., Shah, A. D., Williams, B., Asselbergs, F. W., Mayer, E. K., Lee, R. W., Herbert, C., Grant, S. W., Curzen, N., Squire, I. B., Johnson, T., ... Quint, J. K. (2023). The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions. International journal of chronic obstructive pulmonary disease, 18, 2405-2416. https://doi.org/10.2147/COPD.S432166

@article{f3747716202440a39199363e54c23f60,

title = "The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions",

abstract = "BACKGROUND: No single biomarker currently risk stratifies chronic obstructive pulmonary disease (COPD) patients at the time of an exacerbation, though previous studies have suggested that patients with elevated troponin at exacerbation have worse outcomes. This study evaluated the relationship between peak cardiac troponin and subsequent major adverse cardiac events (MACE) including all-cause mortality and COPD hospital readmission, among patients admitted with COPD exacerbation.METHODS: Data from five cross-regional hospitals in England were analysed using the National Institute of Health Research Health Informatics Collaborative (NIHR-HIC) acute coronary syndrome database (2008-2017). People hospitalised with a COPD exacerbation were included, and peak troponin levels were standardised relative to the 99th percentile (upper limit of normal). We used Cox Proportional Hazard models adjusting for age, sex, laboratory results and clinical risk factors, and implemented logarithmic transformation (base-10 logarithm). The primary outcome was risk of MACE within 90 days from peak troponin measurement. Secondary outcome was risk of COPD readmission within 90 days from peak troponin measurement.RESULTS: There were 2487 patients included. Of these, 377 (15.2\%) patients had a MACE event and 203 (8.2\%) were readmitted within 90 days from peak troponin measurement. A total of 1107 (44.5\%) patients had an elevated troponin level. Of 1107 patients with elevated troponin at exacerbation, 256 (22.8\%) had a MACE event and 101 (9.0\%) a COPD readmission within 90 days from peak troponin measurement. Patients with troponin above the upper limit of normal had a higher risk of MACE (adjusted HR 2.20, 95\% CI 1.75-2.77) and COPD hospital readmission (adjusted HR 1.37, 95\% CI 1.02-1.83) when compared with patients without elevated troponin.CONCLUSION: An elevated troponin level at the time of COPD exacerbation may be a useful tool for predicting MACE in COPD patients. The relationship between degree of troponin elevation and risk of future events is complex and requires further investigation.",

keywords = "Humans, Pulmonary Disease, Chronic Obstructive, Patient Readmission, Hospitalization, Troponin, Cardiovascular Diseases/etiology",

author = "Constantinos Kallis and Amit Kaura and Samuel, \{Nathan A\} and Abdulrahim Mulla and Ben Glampson and Kevin O'Gallagher and Jim Davies and Dimitri Papadimitriou and Woods, \{Kerrie J\} and Shah, \{Anoop D\} and Bryan Williams and Asselbergs, \{Folkert W\} and Mayer, \{Erik K\} and Lee, \{Richard W\} and Christopher Herbert and Grant, \{Stuart W\} and Nick Curzen and Squire, \{Iain B\} and Thomas Johnson and Shah, \{Ajay M\} and Divaka Perera and Kharbanda, \{Rajesh K\} and Patel, \{Riyaz S\} and Channon, \{Keith M\} and Jamil Mayet and Quint, \{Jennifer K\}",

note = "Publisher Copyright: {\textcopyright} 2023 Kallis et al.",

year = "2023",

month = nov,

day = "6",

doi = "10.2147/COPD.S432166",

language = "English",

volume = "18",

pages = "2405--2416",

journal = "International journal of chronic obstructive pulmonary disease",

issn = "1176-9106",

publisher = "Dove Medical Press Ltd",

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Kallis, C, Kaura, A, Samuel, NA, Mulla, A, Glampson, B, O'Gallagher, K, Davies, J, Papadimitriou, D, Woods, KJ, Shah, AD, Williams, B, Asselbergs, FW, Mayer, EK, Lee, RW, Herbert, C, Grant, SW, Curzen, N, Squire, IB, Johnson, T, Shah, AM, Perera, D, Kharbanda, RK, Patel, RS, Channon, KM, Mayet, J & Quint, JK 2023, 'The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions', International journal of chronic obstructive pulmonary disease, vol. 18, pp. 2405-2416. https://doi.org/10.2147/COPD.S432166

The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions. / Kallis, Constantinos; Kaura, Amit; Samuel, Nathan A et al.
In: International journal of chronic obstructive pulmonary disease, Vol. 18, 06.11.2023, p. 2405-2416.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions

AU - Kallis, Constantinos

AU - Kaura, Amit

AU - Samuel, Nathan A

AU - Mulla, Abdulrahim

AU - Glampson, Ben

AU - O'Gallagher, Kevin

AU - Davies, Jim

AU - Papadimitriou, Dimitri

AU - Woods, Kerrie J

AU - Shah, Anoop D

AU - Williams, Bryan

AU - Asselbergs, Folkert W

AU - Mayer, Erik K

AU - Lee, Richard W

AU - Herbert, Christopher

AU - Grant, Stuart W

AU - Curzen, Nick

AU - Squire, Iain B

AU - Johnson, Thomas

AU - Shah, Ajay M

AU - Perera, Divaka

AU - Kharbanda, Rajesh K

AU - Patel, Riyaz S

AU - Channon, Keith M

AU - Mayet, Jamil

AU - Quint, Jennifer K

PY - 2023/11/6

Y1 - 2023/11/6

N2 - BACKGROUND: No single biomarker currently risk stratifies chronic obstructive pulmonary disease (COPD) patients at the time of an exacerbation, though previous studies have suggested that patients with elevated troponin at exacerbation have worse outcomes. This study evaluated the relationship between peak cardiac troponin and subsequent major adverse cardiac events (MACE) including all-cause mortality and COPD hospital readmission, among patients admitted with COPD exacerbation.METHODS: Data from five cross-regional hospitals in England were analysed using the National Institute of Health Research Health Informatics Collaborative (NIHR-HIC) acute coronary syndrome database (2008-2017). People hospitalised with a COPD exacerbation were included, and peak troponin levels were standardised relative to the 99th percentile (upper limit of normal). We used Cox Proportional Hazard models adjusting for age, sex, laboratory results and clinical risk factors, and implemented logarithmic transformation (base-10 logarithm). The primary outcome was risk of MACE within 90 days from peak troponin measurement. Secondary outcome was risk of COPD readmission within 90 days from peak troponin measurement.RESULTS: There were 2487 patients included. Of these, 377 (15.2%) patients had a MACE event and 203 (8.2%) were readmitted within 90 days from peak troponin measurement. A total of 1107 (44.5%) patients had an elevated troponin level. Of 1107 patients with elevated troponin at exacerbation, 256 (22.8%) had a MACE event and 101 (9.0%) a COPD readmission within 90 days from peak troponin measurement. Patients with troponin above the upper limit of normal had a higher risk of MACE (adjusted HR 2.20, 95% CI 1.75-2.77) and COPD hospital readmission (adjusted HR 1.37, 95% CI 1.02-1.83) when compared with patients without elevated troponin.CONCLUSION: An elevated troponin level at the time of COPD exacerbation may be a useful tool for predicting MACE in COPD patients. The relationship between degree of troponin elevation and risk of future events is complex and requires further investigation.

AB - BACKGROUND: No single biomarker currently risk stratifies chronic obstructive pulmonary disease (COPD) patients at the time of an exacerbation, though previous studies have suggested that patients with elevated troponin at exacerbation have worse outcomes. This study evaluated the relationship between peak cardiac troponin and subsequent major adverse cardiac events (MACE) including all-cause mortality and COPD hospital readmission, among patients admitted with COPD exacerbation.METHODS: Data from five cross-regional hospitals in England were analysed using the National Institute of Health Research Health Informatics Collaborative (NIHR-HIC) acute coronary syndrome database (2008-2017). People hospitalised with a COPD exacerbation were included, and peak troponin levels were standardised relative to the 99th percentile (upper limit of normal). We used Cox Proportional Hazard models adjusting for age, sex, laboratory results and clinical risk factors, and implemented logarithmic transformation (base-10 logarithm). The primary outcome was risk of MACE within 90 days from peak troponin measurement. Secondary outcome was risk of COPD readmission within 90 days from peak troponin measurement.RESULTS: There were 2487 patients included. Of these, 377 (15.2%) patients had a MACE event and 203 (8.2%) were readmitted within 90 days from peak troponin measurement. A total of 1107 (44.5%) patients had an elevated troponin level. Of 1107 patients with elevated troponin at exacerbation, 256 (22.8%) had a MACE event and 101 (9.0%) a COPD readmission within 90 days from peak troponin measurement. Patients with troponin above the upper limit of normal had a higher risk of MACE (adjusted HR 2.20, 95% CI 1.75-2.77) and COPD hospital readmission (adjusted HR 1.37, 95% CI 1.02-1.83) when compared with patients without elevated troponin.CONCLUSION: An elevated troponin level at the time of COPD exacerbation may be a useful tool for predicting MACE in COPD patients. The relationship between degree of troponin elevation and risk of future events is complex and requires further investigation.

KW - Humans

KW - Pulmonary Disease, Chronic Obstructive

KW - Patient Readmission

KW - Hospitalization

KW - Troponin

KW - Cardiovascular Diseases/etiology

U2 - 10.2147/COPD.S432166

DO - 10.2147/COPD.S432166

M3 - Article (Academic Journal)

C2 - 37955026

SN - 1176-9106

VL - 18

SP - 2405

EP - 2416

JO - International journal of chronic obstructive pulmonary disease

JF - International journal of chronic obstructive pulmonary disease

ER -

The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions

Abstract

Bibliographical note

Keywords

UN SDGs

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