RT Journal Article
SR Electronic
T1 Convalescent troponin and cardiovascular death following acute coronary syndrome
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1717
OP 1724
DO 10.1136/heartjnl-2019-315084
VO 105
IS 22
A1 Philip D Adamson
A1 David McAllister
A1 Anna Pilbrow
A1 John William Pickering
A1 Katrina Poppe
A1 Anoop Shah
A1 Gillian Whalley
A1 Chris Ellis
A1 Nicholas L Mills
A1 David E Newby
A1 Chris Pemberton
A1 Richard W Troughton
A1 Rob N Doughty
A1 A Mark Richards
YR 2019
UL http://heart.bmj.com/content/105/22/1717.abstract
AB 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.