Abstract 12779: Serial High-Sensitivity Troponin I and Long-Term Risk of Death in Subjects With Suspected Acute Coronary Syndrome

• Published in: Circulation (New York, N.Y.) Vol. 146; no. Suppl_1; p. A12779
• Main Authors: Pareek, Manan, Kragholm, Kristian, Kristensen, Anna Meta, Biering-Srensen, Tor, Byrne, Christina, Fosbol, Emil L, Kober, Lars, Gislason, Gunnar, Olsen, Niels T, Bhatt, Deepak L, Torp-Pedersen, Christian
• Format: Journal Article
• Language: English
• Published: Lippincott Williams & Wilkins 08.11.2022
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.146.suppl_1.12779

IntroductionLong-term prognostic implications of serial high-sensitivity troponin concentrations in subjects with suspected acute coronary syndrome (ACS) are unknown. HypothesisTo determine mortality according to high-sensitivity troponin I (TnI) concentrations and their changes from baseline, in patients with suspected ACS. MethodsUsing Danish registries, we identified individuals with a first diagnosis of myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019 who underwent two high-sensitivity TnI (Siemens TnI Flex® Reagent, 99th percentile 45 ng/l) measurements during the same hospitalization. Prognostic implications of serial sampling were examined stratifying subjects for normal and elevated concentrations, and for relative changes of 20% and 50%. Absolute and relative risks for death from any cause at days 0-30 and 31-365 were calculated through multivariable logistic regression with average treatment effect modeling. ResultsOf the 20,609 individuals included, 2.3% had died at 30 days, while 4.7% of 30-day-survivors died between days 31-365. The standardized risk of death at both 0-30 and 31-365 days was highest among subjects with two elevated TnI concentrations (0-30 days8.0%, 31-365 days11.1%) and lowest among those with two normal TnI concentrations (0-30 days0.5%, 31-365 days2.6%). In neither case did relative changes between measurements clearly affect mortality. Nevertheless, among persons who went from a normal to an elevated TnI concentration, 30-day mortality was highest in those with a >50% rise versus subjects with a less pronounced rise (2.2% vs. <0.1%). The Figure shows the standardized absolute risk of death from any cause from days 31-365. ConclusionsAmong individuals with suspected ACS, those with two elevated TnI concentrations consistently had the highest risk of death. Mortality was very low in subjects with two normal TnI values.