1327

JACC April 5, 2016

Volume 67, Issue 13

Heart Failure and Cardiomyopathies

HIGH-SENSITIVITY CARDIAC TROPONIN I AND RISK OF HOSPITALISATION WITH HEART FAILURE IN
PATIENTS WITH SUSPECTED ACUTE CORONARY SYNDROME: A COHORT STUDY
Poster Contributions
Poster Area, South Hall A1
Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m.

Session Title: Predicting the Future: Biomarkers, Risk Scores, Exercise, and HF Outcomes
Abstract Category: 26. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1102-071

Authors: Dominik Stelzle, Anoop Shah, Martin Denvir, Atul Anand, Fiona Strachan, Andrew Chapman, Nicholas Mills, David McAllister,
BHF/University Centre for Cardiovascular Science, Edinburgh, United Kingdom, Centre for Population Health Sciences, Edinburgh, United
Kingdom
Background: Heart failure may occur following myocardial infarction in patients with significant myocardial injury and left ventricular
systolic impairment. With the development of high-sensitivity cardiac troponin assays we are increasingly identifying patients with minor
myocardial injury. Whether cardiac troponin concentrations remain a useful predictor of heart failure hospitalisation in patients with
suspected acute coronary syndrome is uncertain.
Methods: We identified all consecutive patients (n=4,761) with suspected acute coronary syndrome (age 61±16 years, 57% male)
presenting to three secondary and tertiary care hospitals. All subsequent heart failure hospitalisations were identified through the Scottish
Morbidity Record. Cox-regression models were performed to evaluate the association between peak high-sensitivity cardiac troponin I
concentration and heart failure hospitalisation. C-statistics were estimated in order to evaluate the accuracy of prediction of this outcome.
Results: Following the index presentation, hospitalisation with heart failure occurred in 83 patients (40/1,000 person years, py). Patients
with myocardial infarction at the index presentation had a three-fold increased risk of heart failure hospitalisation compared to all other
patients (93/1,000 vs 31/1,000 py, HR= 2.93, 95%CI 1.86-4.62). In all patients, the risk of heart failure hospitalisation increased per
doubling of troponin concentration (HR=1.85, 95%CI 1.44-2.39). This association was strongest for the subgroup of patients with troponin
concentrations ≤99th centile (HR=2.80, 95%CI 1.81-4.31). Model discrimination improved with addition of troponin to age, sex, diabetes,
hypertension and ischaemic heart disease (c-statistic 0.79 vs 0.85, p<0.001).
Conclusions: Cardiac troponin concentration is an excellent predictor of heart failure hospitalisation in patients with suspected acute
coronary syndrome. Interestingly, stronger associations were observed for patients without myocardial infarction, suggesting that high-
sensitivity cardiac troponin assays may also identify patients at risk of heart failure who may benefit from further investigation and
treatment.