The prognostic value of high sensitivity troponin T 7 weeks after an acute coronary syndrome
- Centre for Cardiovascular and Lung Biology, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Correspondence to Dr Donald S C Ang, Centre for Cardiovascular and Lung Biology, University of Dundee, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK; donaldscang{at}doctors.org.uk
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Contributors DA and AS were involved in the design, analyses and writing up of the manuscript. MK was involved in data collection and result analyses. ED and CL were involved in appraising and writing up of manuscript.
- Accepted 1 May 2012
- Published Online First 11 June 2012
Abstract
Objective The role of high sensitivity troponin T (hs-TnT) in the convalescence phase after an acute coronary syndrome (ACS) is unknown. The authors aim to assess the prognostic utility of a single hs-TnT level at 7-week post-ACS. Second, the authors evaluated whether any serial changes in hs-TnT between the index admission and 7 weeks post-ACS had any link with the prognosis. Third, the authors assessed whether the prognostic utility of hs-TnT is independent of various echocardiographic abnormalities.
Methods The authors measured hs-TnT levels in 326 consecutive patients at 7 weeks after an ACS event. The composite end point of death from any cause or acute myocardial infarction was evaluated over a median duration of 30 months.
Results A high 7-week hs-TnT (>14 ng/l) predicted adverse clinical outcomes independent of conventional risk factors, left ventricular dysfunction and left ventricular hypertrophy on echocardiography (adjusted RR: 2.69 (95% CI 1.45 to 5.00)). Patients with persistent hs-TnT elevation at 7 weeks were also at an increased risk of cardiovascular events compared with those with an initial high hs-TnT which then normalised (unadjusted RR 3.39 (95% CI 2.02 to 5.68)).
Conclusion The authors have demonstrated the prognostic utility of a single 7-week hs-TnT measurement in routine ACS patients and that it could be used to assist medium term risk stratification in this patient cohort. In addition, the authors also showed that hs-TnT predicted long-term adverse prognosis independent of various echo parameters. Future studies should evaluate whether tailoring specific treatment interventions to higher risk individuals as identified by an elevated hs-TnT during the convalescence phase of ACS would improve clinical outcomes.
- High sensitivity troponin T
- 7 weeks post-ACS
- prognosis
- echocardiographic abnormalities
- coronary artery disease
- atherosclerosis
- risk stratification
- EBM
- clinical proof of concept studies
- regional blood flow
- coronary haemodynamics
- chronic heart failure
- aorta
- great vessels and trauma
- arrhythmias
- sudden cardiac death
- ventricular fibrillation
- cardiac function
Footnotes
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Funding British Heart Foundation.
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Competing interests None declared.
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Patient consent Obtained.
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Ethics approval The ethics approval was provided by the Tayside Committee of Medical Research Ethics.
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Provenance and peer review Not commissioned; externally peer reviewed.
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