High-Sensitivity Troponins and Outcomes After Myocardial Infarction

J Am Coll Cardiol. 2018 Jun 12;71(23):2616-2624. doi: 10.1016/j.jacc.2018.03.515.

Abstract

Background: It remains unknown how the introduction of high-sensitivity cardiac troponin T (hs-cTnT) has affected the incidence, prognosis, and use of coronary angiographies and revascularizations in patients with myocardial infarction (MI).

Objectives: The aim of this study was to investigate how the incidence of MI and prognosis after a first MI was affected by the introduction of hs-cTnT.

Methods: In a cohort study, the authors included all patients with a first MI from the Swedish National Patient Registry from 2009 to 2013. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for risk of all-cause mortality, reinfarction, coronary angiographies, and revascularizations in patients with MI diagnosed using hs-cTnT compared with those diagnosed using conventional troponins (cTn).

Results: During the study period, 47,133 MIs were diagnosed using cTn and 40,746 using hs-cTnT. The rate of MI increased by 5% (95% CI: 0% to 10%) after the introduction of hs-cTnT. During 3.9 ± 2.8 years of follow-up, there were 33,492 deaths, with no difference in the risk of all-cause mortality (adjusted HR: 1.00; 95% CI: 0.97 to 1.02). There were, in total, 15,766 reinfarctions during 3.1 ± 2.3 years of follow-up, with the risk of reinfarction reduced by 11% in patients diagnosed using hs-cTnT (adjusted HR: 0.89; 95% CI: 0.86 to 0.91). The use of coronary angiographies (adjusted HR: 1.16; 95% CI: 1.14 to 1.18) and revascularizations (adjusted HR: 1.13; 95% CI: 1.11 to 1.15) increased in the hs-cTnT group.

Conclusions: In a nationwide cohort study including 87,879 patients with a first MI, the introduction of hs-cTnT was associated with an increased incidence of MI, although with no impact on survival. We also found a reduced risk of reinfarction alongside increased use of coronary angiographies and revascularizations.

Keywords: biomarkers; coronary angiography; coronary artery disease; coronary revascularization; incidence; prognosis.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Length of Stay / trends
  • Male
  • Middle Aged
  • Mortality / trends
  • Myocardial Infarction / blood*
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / mortality*
  • Registries*
  • Sweden / epidemiology
  • Treatment Outcome
  • Troponin T / blood*

Substances

  • Biomarkers
  • Troponin T