Abstract
AimsHeart failure may occur following acute myocardial infarction, but with the use of high-sensitivity cardiac troponin assays we increasingly diagnose patients with minor myocardial injury. Whether troponin concentrations remain a useful predictor of heart failure in patients with acute coronary syndrome is uncertain.Methods and resultsWe identified all consecutive patients (n = 4748) with suspected acute coronary syndrome (61 ± 16 years, 57% male) presenting to three secondary and tertiary care hospitals. Cox-regression models were used to evaluate the association between high-sensitivity cardiac troponin I concentration and subsequent heart failure hospitalization. C-statistics were estimated to evaluate the predictive value of troponin for heart failure hospitalization. Over 2071 years of follow-up there were 83 heart failure hospitalizations. Patients with troponin concentrations above the upper reference limit (URL) were more likely to be hospitalized with heart failure than patients below the URL (118/1000 vs. 17/1000 person years, adjusted hazard ratio: 7.0). Among patients with troponin concentrations <URL the rate of heart failure hospitalization was 2.80-fold higher [95% confidence interval (95% CI 1.81–4.31)] per doubling of troponin concentration. On adding troponin to a model with demographic, cardiovascular risk factor, and clinical variables, the prediction of heart failure hospitalization improved considerably (C-statistic 0.80 vs. 0.86, P < 0.001).ConclusionCardiac troponin is an excellent predictor of heart failure hospitalization in patients with suspected acute coronary syndrome. The strongest associations were observed in patients with troponin concentrations in the normal reference range, in whom high-sensitivity cardiac troponin assays identify those at increased risk of heart failure who may benefit from further investigation and treatment.
Highlights
Heart failure is common, important, and costly
Cardiac troponin is an excellent predictor of heart failure hospitalization in patients with suspected acute coronary syndrome
Summary
Important, and costly. More than 15 million people are thought to have heart failure in Europe.[1]. Despite improvements in diagnosis and the development of effective therapies for patients with heart failure, the case-fatality rate at 5-years is 50%.3–6 One of the major causes of heart failure is acute myocardial infarction with symptoms developing in those patients who have sustained significant myocardial injury and ventricular impairment.[7,8] with the development of highsensitivity cardiac troponin assays we increasingly identify patients with minor myocardial injury.[9,10,11,12] Whether cardiac troponin concentration remains a useful predictor in this group of patients is uncertain
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