Convalescent troponin and cardiovascular death following acute coronary syndrome

Adamson, P. D. et al. (2019) Convalescent troponin and cardiovascular death following acute coronary syndrome. Heart, 105(22), pp. 1717-1724. (doi: 10.1136/heartjnl-2019-315084) (PMID:31337669) (PMCID:PMC6855795)

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Abstract

Objectives: High-sensitivity cardiac troponin testing is used in the diagnosis of acute coronary syndromes but its role during convalescence is unknown. We investigated the long-term prognostic significance of serial convalescent high-sensitivity cardiac troponin concentrations following acute coronary syndrome. Methods: In a prospective multicentre observational cohort study of 2140 patients with acute coronary syndrome, cardiac troponin I concentrations were measured in 1776 patients at 4 and 12 months following the index event. Patients were stratified into three groups according to the troponin concentration at 4 months using the 99th centile (women>16 ng/L, men>34 ng/L) and median concentration of those within the reference range. The primary outcome was cardiovascular death. Results: Troponin concentrations at 4 months were measurable in 99.0% (1759/1776) of patients (67±12 years, 72% male), and were ≤5 ng/L (median) and >99th centile in 44.8% (795) and 9.3% (166), respectively. There were 202 (11.4%) cardiovascular deaths after a median of 4.8 years. After adjusting for the Global Registry of Acute Coronary Events score, troponin remained an independent predictor of cardiovascular death (HR 1.4, 95% CI 1.3 to 1.5 per doubling) with the highest risk observed in those with increasing concentrations at 12 months. Patients with 4-month troponin concentrations >99th centile were at increased risk of cardiovascular death compared with those ≤5 ng/L (29.5% (49/166) vs 4.3% (34/795); adjusted HR 4.9, 95% CI 3.8 to 23.7). Conclusions: Convalescent cardiac troponin concentrations predict long-term cardiovascular death following acute coronary syndrome. Recognising this risk by monitoring troponin may improve targeting of therapeutic interventions.

Item Type:Articles
Additional Information:This work was supported by New Zealand Health Research Council (Programme Grants 02/152, 08/070, 11/1070); New Zealand National Heart Foundation; New Zealand Lotteries Grant Board; and the Foundation for Research, Science and Technology.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McAllister, Dr David
Authors: Adamson, P. D., McAllister, D., Pilbrow, A., Pickering, J. W., Poppe, K., Shah, A., Whalley, G., Ellis, C., Mills, N. L., Newby, D. E., Pemberton, C., Troughton, R. W., Doughty, R. N., and Richards, A. M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN:1355-6037
ISSN (Online):1468-201X
Published Online:23 July 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Heart 105(22):1717-1724
Publisher Policy:Reproduced under a Creative Commons License

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