To Be or Not to Be: Elevated Troponin and the Role of Secondary Prevention of Atherosclerotic Cardiovascular Disease in ESKD

Background: Understanding the association between End-Stage Renal Disease (ESRD) and elevated troponin (cTn) is essential for assessing cardiovascular mortality as well as risk stratification and treatment. Our study aims to analyze mortality rates among ESRD patients with elevated cTn as well as explore the effect of aspirin, beta-blockers and statins on mortality outcomes. Methods: This single-center observational retrospective study included ESRD patients admitted with elevated cTn from April 2020 to April 2022. Patients with a single cTn measurement on admission, a repeat cTn less than 6 hours from the initial, and admitted for cardiac arrest were excluded from the study. The SONG-HD modified criteria were used to classify the patients into type 1 MI (acute coronary syndrome), type 2 MI (demand ischemia), and chronic cTn elevation groups, and mortality among these was analyzed. Mortality outcomes in patients on aspirin, statin, and beta-blockers were assessed. Results: 300 patients were included with a mean age of 62±13 years. 60% were male. 48% were Hispanic, 36% Black and 16% were other racial groups. There were no significant differences in mortality rates at admission across Type 1 MI, Type 2 MI, and chronic elevation (p=0.788), and at one year (p=0.699). Aspirin was associated with a significant reduction in mortality at admission (p=0.047) but not at one year (p=0.155). Beta-blockers and statins individually were associated with a significant reduction in mortality both at admission (p=0.001, p=0.005 respectively) and at one year (p=0.049, p=0.024 respectively). When adjusted for age, sex and race, statins were associated with lower mortality odds (OR=0.52, p=0.033) while older age was associated with higher odds (OR=1.024, p= 0.043). Conclusion: MI subtypes and chronic cTn elevation have comparable mortality. Thus it is vital that diagnostic and therapeutic measures are implemented in all ESRD patients with elevated cTn to improve outcomes. Since ESRD is a low-grade inflammatory state with enhanced risk for atherosclerotic cardiovascular disease, statins, and beta-blockers could benefit ESRD patients. Recent studies have suggested this effect however, more research is needed.