Suspected ACS: unexplained high cTn portends death, major AEs

  • J Am Coll Cardiol

  • curated by Jenny Blair, MD
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Among admitted patients with suspected acute coronary syndrome (ACS), unexplained cardiac troponin (cTn) increases predict poor outcomes.
  • Authors suggest workup in these patients.
  • Editorial discusses definition of myocardial injury, alternatives to aggressive testing.

Why this matters

  • Unexplained elevated cTn is sometimes called “troponinemia,” a term authors argue is “trivializing.”

Key results

  • Median follow-up, 4.9 years.
  • Major adverse events ([m]AEs) rose with increasing cTn (HRs; 95% CIs):
    • With highest cTn tertile vs ≤99th percentile in subcohorts 1 and 2:
      • 3.57 (2.30-5.54). 
    • With highest cTn tertiles in subcohort 3 (the healthiest):
      • 2.13 (1.34-3.37); and
      • 2.83 (2.08-3.87).
  • Myocardial infarction (MI), cardiovascular mortality, heart failure (HF) readmissions were main drivers of MAE rates. 

Study design

  • TOTAL-AMI, retrospective cohort study of SWEDEHEART (n=48,872).
  • Based on maximum cTn, researchers stratified patients admitted for suspected ACS, then discharged without specific diagnosis.
  • Subcohorts investigated:
    • 1: Patients without previous MI, revascularization, stroke, congestive HF.
    • 2: Subcohort 1 excluding patients with low renal function.
    • 3: Subcohort 2 excluding patients with low ejection fraction or coronary artery disease.
  • Outcomes included all-cause mortality, MI, cardiovascular mortality, HF hospitalization, stroke.  
  • Funding: Swedish Foundation of Strategic Research.

Limitations

  • Prognostic significance of cTn
  • Acute vs chronic elevations not separated.