Abstract 14033: Differential Prognostic Implications of Peak Troponin Level in Acute Coronary Syndrome Treated With and Without Revascularization
Background: Among patients with ACS, greater myocardial necrosis as assessed by peak troponin level is associated with higher mortality. However, it is unclear whether this prognostic relationship differs between patients treated with and without revascularization.
Methods: We studied 12,628 (97.6%) of the 12,944 ACS patients in the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) study with at least one troponin measurement during index hospitalization. Cox proportional hazards regression was used to examine the univariate relationship between peak troponin level (standardized as the ratio of peak troponin value measured during hospitalization and local laboratory upper limit of normal [ULN]) and revascularization on all-cause mortality at 2 years.
Results: Revascularization (PCI or CABG) was performed during index hospitalization in 8586 (68.0%) patients; compared with patients that did not undergo revascularization, these patients had higher peak troponin levels (median, 23 vs 9.5 times ULN) and greater frequency of multivessel disease (49.6% vs 28.5%). Among patients that did not undergo revascularization, predicted mortality rate at 2 years rises sharply with increasing levels of peak troponin up to a 10-fold troponin ratio, with slight increase thereafter, with higher peak troponin levels. In contrast, increasing peak troponin levels were not associated with higher 2-year predicted mortality rate among revascularized patients (Figure).
Conclusion: There is a differential univariate relationship between the degree of troponin elevation and long-term mortality in ACS patients treated with and without revascularization. Although prognostically important in patients treated without revascularization, the prognostic implications of peak troponin level appear to be minimal in revascularized patients.
- © 2013 by American Heart Association, Inc.