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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Long-Term Prognosis of Non-Ischaemic Myocardial Injury in the Emergency Department: A Propensity Score-Adjusted Study

  • Isabel Jurado-Meléndez1,2
  • Carla Durà-Roldán1,2
  • Alfredo Bardají1,2,3
  • Isabel Fort2,3,4
  • Gilmar Pugnet2,3,5
  • Joan Badía3
  • María Llambrich3
  • José Luis Ferreiro1,2,3
5 affiliations
  1. 1Department of Cardiology, Joan XXIII University Hospital, 43005 Tarragona, Spain
  2. 2Facultat de Medicina i Ciències de la Salut, University Rovira i Virgili, 43003 Tarragona, Spain
  3. 3Institut de Recerca Biomèdica Catalunya Sud (IRB CatSud), 43005 Tarragona, Spain
  4. 4Clinical Laboratory, Catalan Institute of Health, Camp de Tarragona-Teres de l’Ebre, Joan XXIII University Hospital, 43005 Tarragona, Spain
  5. 5Emergency Department, Joan XXIII University Hospital, 43005 Tarragona, Spain
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Abstract

Background/Objectives: Cardiac troponin measurement in the emergency department frequently detects non-ischaemic myocardial injury. Although this condition accounts for most troponin elevations, its clinical management remains uncertain. This study aims to determine its prevalence and evaluate its prognostic implications at a 5-year follow-up. Methods: We conducted a retrospective cohort study of 2715 emergency department patients undergoing systematic cardiac troponin testing, excluding type 1 or 2 acute myocardial infarctions. Patients with non-ischaemic myocardial injury (n = 254, 9.4%) were compared to controls (n = 2461, 90.6%) using propensity score methods (overlap weighting and 1:1 matching). Results: Before matching, patients with non-ischaemic injury were older with higher comorbidities. After overlap weighting, the risks of all-cause mortality (hazard ratio [HR] 1.75, 95% CI 1.45–2.11; p < 0.001) and major adverse cardiovascular events (HR 1.78, 95% CI 1.49–2.13; p < 0.001) remained significantly higher in the non-ischaemic injury group over a median 5.07-year follow-up. In cause-specific Cox analysis, heart failure readmission rate was increased among survivors (HR 1.64, 95% CI 1.16–2.30; p = 0.005); however, when accounting for all-cause mortality as a competing risk, this association attenuated (subdistribution hazard ratio [sHR] 1.27, 95% CI 0.90–1.80; p = 0.168). Recurrent myocardial infarction readmissions did not differ between groups (cause-specific HR 1.61, 95% CI 0.70–3.72; p = 0.265; Fine–Gray sHR 1.26, 95% CI 0.55–2.91; p = 0.596). Conclusions: Incidental detection of non-ischaemic myocardial injury in the emergency department independently predicts a substantially poorer long-term prognosis, predominantly driven by all-cause mortality. These findings highlight the clinical importance of recognizing non-ischaemic injury as a marker of high vulnerability requiring close long-term clinical follow-up.

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Cite

BibTeXRIS
BibTeX
@article{juradomelendez2026longterm,
  title = {{Long-Term Prognosis of Non-Ischaemic Myocardial Injury in the Emergency Department: A Propensity Score-Adjusted Study}},
  author = {Isabel Jurado-Meléndez and Carla Durà-Roldán and Alfredo Bardají and Isabel Fort and Gilmar Pugnet and Joan Badía and María Llambrich and José Luis Ferreiro},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15218312},
  url = {https://www.mdpi.com/2077-0383/15/21/8312},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Long-Term Prognosis of Non-Ischaemic Myocardial Injury in the Emergency Department: A Propensity Score-Adjusted Study
AU  - Isabel Jurado-Meléndez
AU  - Carla Durà-Roldán
AU  - Alfredo Bardají
AU  - Isabel Fort
AU  - Gilmar Pugnet
AU  - Joan Badía
AU  - María Llambrich
AU  - José Luis Ferreiro
PY  - 2026
DA  - 2026/10/25
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218312
UR  - https://www.mdpi.com/2077-0383/15/21/8312
AB  - Background/Objectives: Cardiac troponin measurement in the emergency department frequently detects non-ischaemic myocardial injury. Although this condition accounts for most troponin elevations, its clinical management remains uncertain. This study aims to determine its prevalence and evaluate its prognostic implications at a 5-year follow-up. Methods: We conducted a retrospective cohort study of 2715 emergency department patients undergoing systematic cardiac troponin testing, excluding type 1 or 2 acute myocardial infarctions. Patients with non-ischaemic myocardial injury (n = 254, 9.4%) were compared to controls (n = 2461, 90.6%) using propensity score methods (overlap weighting and 1:1 matching). Results: Before matching, patients with non-ischaemic injury were older with higher comorbidities. After overlap weighting, the risks of all-cause mortality (hazard ratio [HR] 1.75, 95% CI 1.45–2.11; p < 0.001) and major adverse cardiovascular events (HR 1.78, 95% CI 1.49–2.13; p < 0.001) remained significantly higher in the non-ischaemic injury group over a median 5.07-year follow-up. In cause-specific Cox analysis, heart failure readmission rate was increased among survivors (HR 1.64, 95% CI 1.16–2.30; p = 0.005); however, when accounting for all-cause mortality as a competing risk, this association attenuated (subdistribution hazard ratio [sHR] 1.27, 95% CI 0.90–1.80; p = 0.168). Recurrent myocardial infarction readmissions did not differ between groups (cause-specific HR 1.61, 95% CI 0.70–3.72; p = 0.265; Fine–Gray sHR 1.26, 95% CI 0.55–2.91; p = 0.596). Conclusions: Incidental detection of non-ischaemic myocardial injury in the emergency department independently predicts a substantially poorer long-term prognosis, predominantly driven by all-cause mortality. These findings highlight the clinical importance of recognizing non-ischaemic injury as a marker of high vulnerability requiring close long-term clinical follow-up.
SN  - 2077-0383
ER  -