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The prognostic value of a 7-week high sensitivity troponin T level after an acute coronary syndrome
  1. Donald S C Ang,
  2. Michelle P C Kao,
  3. Ellie Dow,
  4. Chim Lang,
  5. Allan Struthers
  1. Centre for Cardiovascular and Lung Biology, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
  1. 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

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

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Footnotes

  • Funding British Heart Foundation.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The ethics approval was provided by the Tayside Committee of Medical Research Ethics.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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