Late Survival Among Patients ≥80 Years with Suspected ACS According to High Sensitivity Troponin T Levels

Abstract

Background: High sensitivity cardiac troponins (Hs-Tn) T or I are pivotal biomarkers in the diagnosis of myocardial infarction (MI) and provide risk stratification in patients who present to emergency departments (ED) with suspected acute coronary syndromes (ACS). Elevation of HsTns are associated with short and long-term mortality, irrespective of whether or not the patient has type 1 MI. Methods: To examine the associations between level(s) of HsTnT and late outcomes among very elderly patients who presented to an ED with suspected ACS, HsTnT levels were measured in 526 consecutive patients ≥ 80 years old who presented to the ED at a hospital in Australia between March and June 2014 with symptoms suggestive of ACS. These patients were divided into four groups based on patients Hs-TnT levels as follows; 1) < 14 ng/L, 2) 15-29 ng/L, 3) 30-49 ng/L,and4)≥50 ng/L. Results: At 19 months median follow-up (IQR 3-33 months) patients (median age 85 [IQR 82-88]), who had Hs-TnT levels ≥50 ng/L had the highest rate of mortality followed by patients who had HsTnT between 30-49 ng/L. However, mortality was lower for patients with lower Hs-TnT levels (<14, and 15-29 ng/L). Among patients with elevated TnT > 14 ng/L levels mortality rate was 39% in those with non-cardiac diagnoses and 31% in those with cardiac diagnoses (p = 0.058) Conclusions: The amount of HsTnT elevation was associated with late mortality, in very elderly patients who presented with symptoms suggestive of ACS, irrespective of their final diagnoses.