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High-sensitivity cardiac troponin T levels, chest pain increase risk for CV outcomes
Patients with detectable levels of high-sensitivity cardiac troponin T in the presence of chest pain and stable troponin levels have an increased risk for CV outcomes and death, according to a study published in the Journal of the American College of Cardiology.
Hospitalizations for chest pain
Andreas Roos, MD, of the department of medicine at Karolinska Institutet in Stockholm, and colleagues reviewed data from 19,460 patients (mean age, 54 years; 50% women) who went to the ED with chest pain and had a high-sensitivity cardiac troponin T analysis performed from January 2011 to October 2014. Patients with MI linked to the ED visit, a glomerular filtration rate of less than 15 mL/min/1.73 m2 or another condition associated with an acute increase in high-sensitivity cardiac troponin T levels were excluded.
Information such as laboratory data, comorbidities, outcomes, medication use and causes of death were reviewed. Patients were followed up for a mean of 3.3 years.
High-sensitivity cardiac troponin T levels less than 5 ng/L were seen in 62% of patients, 21% had levels between 5 ng/L and 9 ng/L, 8.6% had levels between 10 ng/L and 14 ng/L and 7.9% of patients had levels greater than 14 ng/L.
During follow-up, 6.9% of patients died. Compared with patients with high-sensitivity cardiac troponin T levels less than 5 ng/L, all-cause mortality was linked to the following after adjusting for multiple variables:
high-sensitivity cardiac troponin T levels 5 ng/L to 9 ng/L: HR = 2; 95% CI, 1.66-2.42;
high-sensitivity cardiac troponin T levels 10 ng/L to 14 ng/L: HR = 2.92; 95% CI, 2.38-3.59;
high-sensitivity cardiac troponin T levels 15 ng/L to 29 ng/L: HR = 4.07; 95% CI, 3.28-5.05;
high-sensitivity cardiac troponin T levels 30 ng/L to 49 ng/L: HR = 6.77; 95% CI, 5.22-8.78; and
high-sensitivity cardiac troponin T levels at least 50 ng/L: HR = 9.68; 95% CI, 7.18-13.
The adjusted risk for CV mortality increased threefold in patients with high-sensitivity cardiac troponin T levels between 5 ng/L and 9 ng/L and 27 times in those with levels of at least 50 ng/L compared with patients with levels less than 5 ng/L. Risk for non-CV death increased with high-sensitivity cardiac troponin T levels was significant, but weaker vs. CV death.
Risk for MI, HF
Patients with high-sensitivity cardiac troponin T levels between 10 ng/L and 14 ng/L had twice the risk for MI after adjustment, and those with levels greater than that had a two- to threefold increased risk.
During follow-up, the adjusted risk for HF hospitalization increased fourfold in patients with high-sensitivity cardiac troponin T levels between 5 ng/L and 9 ng/L and sixfold in those with levels of 10 ng/L to 14 ng/L. The adjusted risk for HF increased by 11- to 13-fold in patients with levels greater than 14 ng/L.
“In the absence of clinical guidelines, we strongly believe that persistently elevated hs-cTnT levels may be reason in itself to investigate patients for exclusion of previously undiagnosed heart disease,” Roos and colleagues wrote. “In addition, future research should focus on how to mitigate risk for patients with no detectable heart disease that may explain persistently elevated hs-cTnT levels.”
“The data presented by Roos et al should remind clinicians not to be falsely reassured when ACS is ‘ruled out’ by a lack of dynamic changes or a Tn level that is measurable but below the 99th percentile threshold,” Marc P. Bonaca, MD, MPH, assistant professor at Harvard Medical School and cardiovascular medicine specialist at Brigham and Women’s Hospital, wrote in a related editorial. “Even in the presence of apparent clinical stability and no apparent acute condition, these patients remain at heightened intermediate- to long-term risk. We must begin to interpret hs-cTn in this context as an indicator of important subclinical disease that warrants additional evaluation.” – by Darlene Dobkowski
Disclosure s : Roos and Bonaca report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.