Author + information
- Andreas Roos,
- Nadia Bandstein,
- Magnus Lundbäck,
- Ola Hammarsten,
- Rickard Ljung and
- Martin Holzmann
Background: There is a paucity of data on the association between high-sensitivity cardiac troponins (hs-cTn) and mortality. We hypothesized that hs-cTnT levels above the limit of detection (>4 ng/l), but within the normal range (<15 ng/l) may be associated with increased long-term mortality.
Methods: All patients (n=22,589) >25 years with chest pain and hs-cTnT levels analyzed in the ED at our hospital during 2011-2014 were eligible for inclusion. We scrutinized 4052 medical records in patients with hs-cTnT levels >14 ng/l, to exclude those with acute illnesses (n=1439 excluded). Also, patients with MI (n=1269), and end-stage renal disease (n=131) were excluded. Data on characteristics, medication and mortality was retrieved from National Health Care registers. We used Cox regression to calculate hazard ratios (HR) with 95% confidence intervals (CI) for all-cause mortality after adjustment for age, sex, kidney function, stroke, MI, heart failure, revascularization, atrial fibrillation, diabetes, and cardiovascular medication in the following categories of hs-cTnT: 5-9, 10-14, 15-29, 30-49, and 50 ng/l, using <5 ng/l as referent.
Results: In total 19,750 patients with a mean age of 54 (±17) years were included, of whom 62%, 21%, 8.5%, 6.4%, 1.8% and 1.0% had hs-cTnT levels of <5, 5-9, 10-14, 15-29, 30-49, and 50 ng/l, respectively. Higher hs-cTnT levels were associated with older age, male sex, kidney dysfunction, and comorbidities. During a mean follow-up of 3.3 (±1.2) years (65,196 person-years) in total 1448 (7.3%) patients died. With increasing hs-cTnT levels the incidence rate of death increased from 0.52 (<5 ng/l), to 27 (50 ng/l) per 100 person-years. Adjusted HRs with 95% CI for death was 2.07 (1.72-2.50), 3.06 (2.50-3.76), 4.62 (3.76-5.68), 7.07 (5.52-9.06), and 9.67 (7.36-13) in patients with 5-9, 10-14, 15-29, 30-49, and 50 ng/l, respectively.
Conclusions: We found that already a hs-cTnT level of 5-9 ng/l was associated with a two-fold risk of long-term mortality, and that the risk of death increased in a graded manner with increasing levels of hs-cTnT. Our data indicate that any detectable level of hs-cTnT is associated with an increased risk of death and should merit further attention.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Coronary Syndromes, Diagnosis, Management and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1253-340
- 2017 American College of Cardiology Foundation