The predictive value of high sensitivity-troponin velocity within the first 6 h of presentation for cardiac outcomes regardless of acute coronary syndrome diagnosis. (1st February 2016)

• Record Type: Journal Article
• Authors: Chuang, Anthony; Hancock, David G.; Horsfall, Matthew; Alhammad, Nasser J.; Zhou, Julia; Cullen, Louise; French, John; Chew, Derek P.
• Is Part Of: International journal of cardiology. Volume 204(2016)
• Page Start: 106
• Page End: 111
• Publication Date: 2016-02-01
• Subjects: Myocardial infarction -- hs-Troponin -- Risk prediction; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.11.132
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Low-range troponin elevations without clear coronary manifestations remain a major diagnostic challenge. We sought to determine if troponin velocity could allow for early identification of patients without an obvious cardiac diagnosis and who are at increased risk for cardiac-specific events. Methods & results: All patients presenting to South Australian public hospitals between 1 September 2011 and 30 September 2012, with at least two troponin measurements during the first 6 h after ED presentation were included. Diagnoses were classified as 'coronary', 'non-coronary cardiac', and 'non-cardiac' using the International Classification of Diseases 10 codes. The relationship between troponin velocity and cardiac-specific mortality and combined cardiac outcome (death and myocardial infarction) was assessed using Fine and Gray competing risk models in patients with an initial troponin < 52 ng/L. Sensitivity analyses were performed using different initial and maximum troponin cut-off values. In total, 7300 patients were identified. A troponin velocity of 2.5 ng/L/h or greater in the non-cardiac (n = 2793) patient group was significantly associated with an increased risk for 12-month cardiac mortality (sub-hazard ratio [SHR] 2.90, 95% CI 1.33–6.34) and combined cardiac outcome (SHR 2.08, 95% CI 1.01–4.27). This association was consistent for coronary (n = 3835) and non-coronary cardiac (n = 672) patient groups, and remained after sensitivity analyses. Conclusions: The significant association observed across all patient groups suggests that troponin velocity could be used for early risk stratification of patients with low-range troponin elevations without clear cardiac symptoms. These results may help guide future clinical trials aimed at assessing the utility of cardiac-targeted interventions in this challenging patient population.