Abstract 12886: In-hospital and Early Post-discharge Troponin Elevations Among Patients Hospitalized for Heart Failure: Insights From the ASTRONAUT Trial
Introduction: Troponin level is commonly elevated among patients hospitalized for heart failure (HF) and may correlate with worse clinical outcomes. The prognostic significance of early post-discharge troponin level and persistent troponin elevation is unclear.
Methods: The ASTRONAUT trial randomized 1,615 hospitalized HF patients with ejection fraction ≤40% to daily aliskiren or placebo, in addition to standard care. Troponin I was measured per protocol at baseline and 1-month in a core lab with elevated level defined as >0.04 ng/mL. Outcomes were compared by presence/ absence of troponin I elevation at baseline and 1-month. Landmark analysis was performed to account only for events subsequent to troponin measurement.
Results: Overall, 1,469 (91.0%) patients had troponin data at baseline, of which 609 (41.5%) had elevated levels (median 0.10 ng/mL). At 1 month, 1,301 (80.6%) patients had troponin data, of which 389 (29.9%) had elevated levels (median 0.10 ng/mL). Among patients with baseline elevated troponin with troponin data at 1 month, 313/518 (60.4%) had persistently elevated troponin level. After adjustment, elevated baseline troponin was not significantly associated with 1-year all-cause death or cardiovascular mortality/ HF hospitalization (Table). However, 1-month troponin elevation was independently predictive of 1-year clinical outcomes. The association between 1-month troponin elevation and outcomes was not influenced by presence/ absence of baseline troponin elevation (P for interaction ≥ 0.69).
Conclusion: Troponin I was elevated in >40% of hospitalized HF patients, and remained persistently elevated in >60% of these patients early post-discharge. Elevated troponin I levels at 1-month follow-up, but not during hospitalization, were independently predictive of increased clinical events. Measurement of troponin I during the early post-discharge vulnerable phase should be considered as a practical means of risk stratification.
Author Disclosures: S.J. Greene: None. F. Zannad: Research Grant; Modest; Roche Diagnostics. Other; Modest; Air Liquide, Bayer HealthCare, Biomérieux, Biotronik, Boston Scientific, CVRx, Janssen Pharmaceuticals, Inc., Novartis AG, Pfizer Inc., ResMed, Sanofi U.S., Servier, St. Jude Medical, , Takeda Development Center Americas, Inc., Mitsubishi, CardioRenal Diagnostics. G.C. Fonarow: Research Grant; Significant; NIH. Consultant/Advisory Board; Modest; Amgen, Janssen. Consultant/Advisory Board; Significant; Novartis. H. Subacius: None. M. Triggiani: None. A.P. Ambrosy: None. M. Böhm: Consultant/Advisory Board; Modest; AstraZeneca, Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, AWD Dresden, Berlin-Chemie, MSD, Novartis, Pfizer, Sanofi-Aventis, Servier. J. Butler: Other Research Support; Significant; National Institutes of Health, European Union, Health Resource Services Administration, and Food and Drug Administration, Amgen. Consultant/Advisory Board; Modest; Takeda, Medtronic, Z Pharma, Zensun, Celladon, Gambro, GE Healthcare, Janssen, Ono. Consultant/Advisory Board; Significant; Bayer, CardioCell, Merck, Novartis, Relypsa, Trevena,. O. Chioncel: Research Grant; Modest; Abbott, Servier, Vifor. Consultant/Advisory Board; Modest; Novartis. A.P. Maggioni: Other; Modest; Served on committees of clinical studies sponsored by Amgen, Bayer, Abbott Vascular, Cardiorentis, Johnson & Johnson, Novartis Pharma AG. S.D. Solomon: Research Grant; Significant; Novartis. Consultant/Advisory Board; Significant; Novartis. M. Vaduganathan: None. M. Gheorghiade: Consultant/Advisory Board; Modest; Abbott Laboratories, Astellas, Astra Zeneca, CorThera Inc., Cytokinetics Inc., Errekappa Terapeutici, GlaxoSmithKline, Johnson & Johnson, Merck, Protein Design Laboratories, Sanofi-Aventis. Consultant/Advisory Board; Significant; Bayer Schering Pharma AG, DebioPharm SA, Medtronic, Novartis Pharma AG, Otsuka Pharmaceuticals, PeriCor Therapeutics, Sigma Tau, Solvay Pharmaceuticals. M. Senni: Consultant/Advisory Board; Modest; Abbott Vascular, Novartis, and Bayer.
- © 2016 by American Heart Association, Inc.