Serial troponin-T and long-term outcomes in suspected acute coronary syndrome

Area of Science:

• Cardiology
• Biomarkers
• Clinical Diagnostics

Background:

• Prognostic implications of serial high-sensitivity troponin (hsTnT) in suspected acute coronary syndrome (ACS) are not well understood.
• Early risk stratification in ACS is crucial for patient management and outcomes.

Purpose of the Study:

• To investigate the long-term prognostic value of serial high-sensitivity troponin-T (hsTnT) measurements in patients with suspected acute coronary syndrome (ACS).
• To determine the association between hsTnT concentration changes and mortality risk within the first year after presentation.

Main Methods:

• Retrospective analysis of Danish national registry data from 2012-2019.
• Inclusion of 28,902 individuals with suspected ACS undergoing two hsTnT measurements 1-7 hours apart.
• Multivariable logistic regression with average treatment effect modeling to assess mortality risk (0-30 days and 31-365 days) stratified by hsTnT levels and changes.

Main Results:

• The highest standardized risk of death was observed in subjects with two elevated hsTnT concentrations (0-30 days: 4.3%; 31-365 days: 7.2%).
• A significant increase in 30-day mortality was noted for those with a >20% to 50% or >50% rise in hsTnT.
• Mortality risk was very low in subjects with two normal hsTnT concentrations (0-30 days: 0.1%; 31-365 days: 0.9%), independent of measurement changes.

Conclusions:

• Consecutively elevated hsTnT concentrations in suspected ACS patients are associated with the highest mortality risk.
• Normal hsTnT concentrations on serial testing indicate a very low risk of death, irrespective of minor fluctuations between measurements.