Influence of age and comorbidities on the level of high sensitive cardiac troponin T (hs-cTnT) in the geriatric population

Abstract

Abstract. – A high level of troponin correlates significantly with the risk of death or recurrence of myocardial infarction. However, most of these studies have been obtained in middle-aged people. It is considered that ageing is associated with increased troponin levels. This can be a major drawback for the stratification and diagnostic of acute coronary syndrome in elderly patients. Our study was designed to determine the predictive value of high-sensitivity cardiac troponin T (Hs-cTnT) in the elderly and very elderly patients and mainly in the presence of concomitant diseases. Materials and Methods: We retrospectively evaluated 6 977 medical records of patients aged ≥ 65 years and admitted for patients admitted to the hospital for chest pain. Three age groups were formed: patients aged 65 to 74 years (young-old), patients aged 75 to 84 years (old) and patients ≥85 years old (old-old). Three categories were formed according to the Hs-cTnT levels: 0-14 ng/L, 15-31 ng/L and ≥32 ng/L. Seventeen comorbidities were identified and patients were grouped into four categories according to the number of comorbidities: 1 or 2 comorbidities, 3 comorbidities, 4-5 comorbidities and ≥ 6 comorbidities. Results:3 439 male patients (50. 4%) were included in this current study among which 2 414 patients had six or more comorbidities (35.4%). For our cohort, whose average age was 78.3 years, the Hs-cTnT level was 79.9 ng/l. In both sexes, the troponin value across all age groups, with any types of comorbid disease excluding any cardiac diseases, was remarkably high compared to the normal troponin values (p<0.05). Our results also demonstrated that the Hs-cTnT levels increased in the presence of comorbidities independently of their number (p<0.05). In the old-old group the troponin levels decreased even when comorbidities were present suggesting that age is not the determinant factor in the troponin increase. Conclusion: Advanced age could not be associated to an elevation of Hs-cTnT; in contrast, cardiac troponin elevation was the result of pre-existed comorbidities independently of their number. Increased troponin level in elderly should always be considered as pathological and a specific etiology searched.