Abstract
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.
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