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)

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, Professor 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 > School of Health & 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