High-sensitivity cardiac troponin I and risk of heart failure in patients with suspected acute coronary syndrome: a cohort study

Stelzle, D., Shah, A. S.V., Anand, A., Strachan, F. E., Chapman, A. R., Denvir, M. A., Mills, N. L. and McAllister, D. A. (2018) High-sensitivity cardiac troponin I and risk of heart failure in patients with suspected acute coronary syndrome: a cohort study. European Heart Journal: Quality of Care and Clinical Outcomes, 4(1), pp. 36-42. (doi: 10.1093/ehjqcco/qcx022) (PMID:29045610) (PMCID:PMC5805120)

[img]
Preview
Text
143264.pdf - Published Version
Available under License Creative Commons Attribution.

216kB

Abstract

Aims: Heart failure may occur following acute myocardial infarction, but with the use of high-sensitivity cardiac troponin assays we increasingly diagnose patients with minor myocardial injury. Whether troponin concentrations remain a useful predictor of heart failure in patients with acute coronary syndrome is uncertain. Methods and results: We identified all consecutive patients (n = 4748) with suspected acute coronary syndrome (61 ± 16 years, 57% male) presenting to three secondary and tertiary care hospitals. Cox-regression models were used to evaluate the association between high-sensitivity cardiac troponin I concentration and subsequent heart failure hospitalization. C-statistics were estimated to evaluate the predictive value of troponin for heart failure hospitalization. Over 2071 years of follow-up there were 83 heart failure hospitalizations. Patients with troponin concentrations above the upper reference limit (URL) were more likely to be hospitalized with heart failure than patients below the URL (118/1000 vs. 17/1000 person years, adjusted hazard ratio: 7.0). Among patients with troponin concentrations <URL the rate of heart failure hospitalization was 2.80-fold higher [95% confidence interval (95% CI 1.81–4.31)] per doubling of troponin concentration. On adding troponin to a model with demographic, cardiovascular risk factor, and clinical variables, the prediction of heart failure hospitalization improved considerably (C-statistic 0.80 vs. 0.86, P < 0.001). Conclusion: Cardiac troponin is an excellent predictor of heart failure hospitalization in patients with suspected acute coronary syndrome. The strongest associations were observed in patients with troponin concentrations in the normal reference range, in whom high-sensitivity cardiac troponin assays identify those at increased risk of heart failure who may benefit from further investigation and treatment.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McAllister, Professor David
Authors: Stelzle, D., Shah, A. S.V., Anand, A., Strachan, F. E., Chapman, A. R., Denvir, M. A., Mills, N. L., and McAllister, D. A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
Journal Name:European Heart Journal: Quality of Care and Clinical Outcomes
Publisher:Oxford University Press
ISSN:2058-5225
ISSN (Online):2058-1742
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in European Heart Journal: Quality of Care and Clinical Outcomes 4(1):36-42
Publisher Policy:Reproduced under a Creative Commons License

University Staff: Request a correction | Enlighten Editors: Update this record

Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
620161High-Sensitive Troponin in the evaluation of patients with Acute Coronary Syndrome (HighSTEACS): A randomised control trialColin BerryBritish Heart Foundation (BHF)SP/12/10/29922RI CARDIOVASCULAR & MEDICAL SCIENCES
754451Combining efficacy estimates from clinical trials with the natural history obtained from large routine healthcare databases to determine net overall treatment benefitsDavid McAllisterWellcome Trust (WELLCOTR)201492/Z/16/ZIHW - PUBLIC HEALTH