Even a slight rise in troponin is tied to early mortality risk in all age groups

  • Kaura A & al.
  • BMJ
  • 20 Nov 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Elevated troponin level, even if raised only slightly above normal, was associated with a clinically important increased mortality, regardless of age.
  • The excess mortality associated with a raised troponin level was heavily concentrated in the first few weeks.
  • Findings suggest that even slightly raised troponin levels have marked prognostic significance, however, clinical decisions should depend on the underlying disease.

Study design

  • Retrospective study of 257,948 patients (median age 65 years) who underwent troponin testing between 2010 and 2017.
  • Outcome: all-cause mortality.
  • Funding: National Institute for Health Research Imperial Biomedical Research Centre.

Key results

  • Over a median follow-up of 1198 days (interquartile range 514-1866 days), 55850 (21.7%) deaths occurred.
  • Positive vs negative troponin level was associated with a higher risk for mortality over 3 years (HR, 3.2; 95% CI, 3.1-3.2).
  • HR for a positive troponin result attenuated markedly with age, from 10.6 (95% CI, 8.5-13.3) in 18-29 years old to only 1.5 (95% CI, 1.4-1.6) in those >90 years.
  • Higher level of troponin was associated with ~15 percentage points higher risk for 3-year mortality in all age groups.
  • Troponin level showed a direct association with mortality in patients without acute coronary syndrome [ACS] (n=120,049).
  • However, it showed an inverted U-shaped relation in patients with ACS (n=14,468), with a paradoxical decline in mortality at peak troponin levels >70x upper limit of normal.

Limitations

  • Retrospective design.