Abstract 18610: High-sensitivity Cardiac Troponin T Level in the Emergency Department and Long-term Mortality in Patients With and Without Myocardial Infarction
Introduction: The level of high-sensitivity cardiac troponin T (hs-cTnT) is related to outcome in patients with myocardial infarction (MI). However, the importance of elevated hs-cTnT levels in patients without MI is unknown. We investigated the association between elevation of hs-cTnT and death in patients with and without MI. Also, we compared the risk of death between patients with and without MI at different levels of hs-cTnT.[[Unable to Display Character:
Methods: We included all patients > 25 years of age who came to the emergency department (ED), at the Karolinska university hospital in Stockholm, Sweden, during 2011 to 2012, with chest pain and at least one hs-cTnT measured. Cox hazard regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI), for all-cause mortality at different levels of first hs-cTnT (5-14, 15-29, 30-49, 50-100, and >100 ng/l), using <5 ng/l as reference category, after adjustment for age, sex, prior MI, stroke, heart failure, renal function and diabetes. In addition, HRs for death in each strata of hs-cTnT in patients with compared with no MI were calculated.[[Unable to Display Character:
Results: 13 735 patients were included of whom 817 (5.9%) had MI. During 1.7 years of follow-up 99 (12%) patients with, and 729 (5.6%) without MI died. The assocation between hs-cTnT level and death was stronger in patients without MI, than among those with MI in each strata (5-14, 15-29, 30-49, 50-100, and >100 ng/l) of hs-cTnT (HR 95% CI: 2.7 (2.0-3.5) vs 1.9 (0.3-16), 4.7 (3.5-6.3) vs 2.0 (0.3-15), 7.4 (5.3-109) vs 2.2 (0.3-16), 11.2 (7.9-16) vs 2.0 (0.3-16), and 9.3 (6.4-13) vs 3.3 (0.4-24)). MI was associated with a lower risk of death compared with no MI in all strata of hs-cTnT > 14 ng/l. In patients with a hs-cTnT level of 50-100 ng/l the risk of death associated with MI compared with no MI was 0.39 (0.22 to 0.70).[[Unable to Display Character:
Conclusions: An elevated first hs-cTnT is a stronger predictor of death in patients without MI than in those with MI. Patients with compared to those without MI have a lower risk of death at each level of elevated hs-cTnT.
Author Disclosures: N. Bandstein: None. R. Ljung: None. M. Johansson: None. M. Holzmann: None.
- © 2014 by American Heart Association, Inc.