Author + information
- Received August 22, 2018
- Revision received September 28, 2018
- Accepted September 30, 2018
- Published online January 7, 2019.
- aDepartment of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- bDepartment of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- ↵∗Address for correspondence:
Dr. Kai M. Eggers, Department of Medical Sciences, Cardiology, Uppsala University, S-751 85 Uppsala, Sweden.
Background Cardiac troponin (cTn) elevation is a common finding in acutely admitted patients, even in the absence of acute coronary syndrome. In some of these patients, no etiology of cTn elevation can be identified. The term troponinemia is sometimes used to describe this scenario.
Objectives This study aimed to investigate the associations of cTn levels with clinical findings and long-term outcome in acutely admitted patients with suspected acute coronary syndrome who had been discharged without a specified diagnosis.
Methods Retrospective registry-based cohort study investigating 48,872 patients (SWEDEHEART [Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies] registry). Patients were stratified into cohorts with cTn levels less than or equal to the assay-specific 99th percentile and separated by assay-specific cTn tertiles in case of higher levels.
Results A cTn level >99th percentile was noted in 9,800 (20.1%) patients. The prevalence of cardiovascular risk factors as well as cardiovascular and noncardiovascular comorbidities increased across higher cTn strata. In total, 7,529 (15.4%) patients had a major adverse event (MAE), defined as the composite of all-cause mortality, myocardial infarction, readmission for heart failure, or stroke (median follow-up 4.9 years). MAE risk was associated with higher cTn strata (hazard ratio for highest assay-specific cTn tertile: 2.59; 95% confidence interval: 2.39 to 2.80; hazard ratio in patients without cardiovascular comorbidities, renal dysfunction, left ventricular dysfunction, or significant coronary stenosis: 3.57; 95% confidence interval: 2.30 to 5.54).
Conclusions cTn elevation is associated with cardiovascular and noncardiovascular comorbidities and predicts major adverse events in acutely admitted patients, in whom no definite diagnosis could have been established. The term troponinemia is trivializing and should be avoided. Instead, careful work-up is required in these patients.
The TOTAL-AMI project has received funding from the Swedish Foundation of Strategic Research. Dr. Eggers has received a research grant from Abbott Laboratories. Dr. Lindahl has served as a consultant for Roche Diagnostics, Thermo Fisher Scientific, bioMérieux Clinical Diagnostics, and Philips Healthcare; and has received research grants from bioMérieux Clinical Diagnostics. Dr. Jernberg has reported that he has no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received August 22, 2018.
- Revision received September 28, 2018.
- Accepted September 30, 2018.
- 2019 American College of Cardiology Foundation
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