The Prognostic Value of Cardiac Troponin in a Contemporary Cohort of Patients With First-Time Myocardial Infarction

Abstract

The prognostic value of cardiac troponin following myocardial infarction (MI) is well documented; however, the benefit in a predominantly revascularised cohort is less certain. This study reported the prognostic role of peak cardiac troponin in the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS). Due to varying troponin assays across hospitals, peak troponin data from the index admission were standardised as the peak troponin divided by the upper limit of normal (ULN) for each troponin assay (“peak troponin ratio”). Troponin ratio was categorically investigated (≤1, >1–10, >10–100, >100 over ULN) and as a continuous variable. The relationship between troponin and all-cause death or cardiovascular readmission was investigated using Cox regression including restricted cubic splines. Models were adjusted for the MENZACS clinical summary score (comprising 20 clinical factors including age and sex), ethnicity, and log2 N-terminal pro B-type natriuretic peptide (NT-proBNP). A total of 1,876 patients admitted with first-time MI from 2015 to 2019 were included (mean age 61 years, 21% women, 43% ST-elevation MI, 57% non-ST elevation MI); 99% received coronary angiography and 88% were revascularised during the index admission. Peak troponin ratio was 1% ≤1, 19% >1–10, 36% >10–100,and 44% >100. The NT-proBNP increased with increasing troponin category. Overall, 20% patients died or were readmitted over a median of 3.5 years. After multivariable adjustment, peak troponin ratio was not associated with death or readmission (Figure 1). Peak troponin was not an independent predictor of death or cardiovascular readmission in a highly revascularised cohort of patients in New Zealand surviving admission for a first-time MI.