Abstract P362: Prognostic Value of Troponin in Myocardial Infarction in the Community

Abstract

Troponin is the biomarker of choice for the diagnosis of myocardial infarction (MI) in clinical practice. Data on its value to predict death, while documented in clinical trials, are lacking from community studies. There is little information from population studies of MI on short and long term predictive value of Troponin on death and nonfatal endpoints such as recurrent ischemic events and heart failure. Methods: We evaluated the prognostic value of Troponin T (TnT) among consecutive persons with incident MI in Olmsted County, MN. Results: 1220 persons (mean age 69±15 years, 45% women) experienced an incident MI (20% ST elevation MI) in Olmsted County, MN between 2002 and 2008. Peak TnT value measured at a median of 1 day post-MI was 1.88±4.19 ng/mL (median 0.52 (25%: 0.16, 75%: 1.75)). After 1.27 years of follow-up, 294 deaths occurred, 360 recurrent ischemic events (recurrent MI or hospitalized unstable angina) and 345 episodes of heart failure. Associations between clinical events and TnT tertiles are shown in the table . Conclusions: In the community, the magnitude of TnT elevation is predictive of recurrent ischemic events, heart failure and early death. It is not associated with long-term mortality. Hazard ratio compared to lowest TnT tertile, 95%CI and p value Adjusted for age, sex and comorbidity Outcome All events Events within 30 days Events among 30 day survivors Death TnT tertile 2 TnT tertile 3 p-value 1.02 (0.78-1.33) 1.15 (0.85-1.57) 0.64 0.64 (0.38-1.06) 1.59 (0.98-2.57) 0.004 1.24 (0.90-1.69) 0.93 (0.62-1.38) 0.26 Recurrent ischemic events TnT tertile 2 TnT tertile 3 p-value 1.45 (1.12-1.88) 1.70 (1.29-2.24) <0.001 1.45 (0.96-2.19) 2.07 (1.37-3.12) 0.002 1.46 (1.05-2.04) 1.45 (1.00-2.10) 0.049 Heart failure TnT tertile 2 TnT tertile 3 p-value 1.03 (0.78-1.36) 2.10 (1.58-2.78) <0.001 0.94 (0.68-1.29) 2.10 1.54-2.87) <0.001 1.38 (0.79-2.41) 2.19 (1.14-4.21) 0.067