Convalescent troponin and cardiovascular death following acute coronary syndrome
Philip D Adamson1,2, David McAllister3, Anna Pilbrow1
1Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand.
Insights
Convalescent high-sensitivity cardiac troponin levels after acute coronary syndrome predict long-term cardiovascular death. Monitoring these troponin levels can help identify high-risk patients for targeted therapies.
Area of Science:
- Cardiology
- Biomarkers
- Prognostics
Background:
- High-sensitivity cardiac troponin (hs-cTn) testing is crucial for diagnosing acute coronary syndromes.
- The prognostic role of hs-cTn levels during the convalescent phase remains largely unknown.
- Understanding long-term risk stratification is vital for post-acute coronary syndrome patient management.
Purpose of the Study:
- To investigate the long-term prognostic significance of serial convalescent high-sensitivity cardiac troponin concentrations.
- To determine if troponin levels measured months after an acute coronary syndrome can predict future cardiovascular events.
- To assess the association between convalescent troponin levels and cardiovascular mortality.
Main Methods:
- A prospective, multicentre observational cohort study involving 2140 patients with acute coronary syndrome.
- Serial cardiac troponin I measurements were taken at 4 and 12 months post-event in 1776 patients.
- Patients were stratified based on 4-month troponin concentrations relative to the 99th centile and median reference ranges.
Main Results:
- Convalescent troponin concentrations were measurable in 99% of patients.
- Elevated troponin levels at 4 months were independently associated with increased long-term cardiovascular death risk (adjusted HR 1.4 per doubling).
- Patients with 4-month troponin concentrations above the 99th centile had a significantly higher risk of cardiovascular death (adjusted HR 4.9) compared to those with levels ≤5 ng/L.
Conclusions:
- Convalescent cardiac troponin concentrations are significant predictors of long-term cardiovascular death after acute coronary syndrome.
- Monitoring troponin levels during convalescence can identify patients at elevated risk.
- This risk stratification may enable more precise targeting of therapeutic interventions to improve outcomes.
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.
Trial Registration Number:
ACTRN12605000431628;Results.
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01:14Overview of the Cardiovascular System
Heart
The heart is the central pump of the cardiovascular system that circulates blood throughout the body. It comprises two atria receiving the blood and two ventricles pumping blood out of the heart. Their rhythmic contractions, called heartbeats, ensure that blood flow remains continuous.
Blood Vessels
Blood...