Prognosis in relation to high-sensitivity cardiac troponin T levels in patients with myocardial infarction and non-obstructive coronary arteries.

Abstract

BACKGROUND:

Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a recently recognized condition where biomarkers and prognosis are less well studied than in MI with obstructive coronary artery disease (MI-CAD). We therefore aimed to investigate the one-year prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) levels in MINOCA in comparison to MI-CAD.

METHODS:

In this registry-based cohort study, we used data from patients with a discharge diagnosis of MI, admitted between 2009 and 2013 to Swedish hospitals using the hs-cTnT assay. Only patients without previously known coronary artery disease were considered. Patients with and without coronary stenosis >50% were regarded to have MI-CAD and MINOCA, respectively. Assessed outcomes included all-cause mortality, cardiovascular (CV) mortality and major CV events (MACE), defined as the composite of CV death or admissions for non-fatal MI, heart failure (HF) or ischemic stroke.

RESULTS:

The study cohort consisted of 1639 MINOCA and 17,304 MI-CAD patients. In adjusted analyses, hs-cTnT (ln) in MINOCA patients predicted all-cause mortality (HR 1.32 [95% CI 1.11-1.56]), CV mortality (HR 2.11 [95% CI 1.51-2.96]) and MACE (HR 1.44 [95% CI 1.20-1.72]). Hs-cTnT (ln) also predicted readmissions for HF (HR 1.51 [95% CI 1.51-2.96]) but not non-fatal MI or stroke. Interaction analyses suggested that hs-cTnT (ln) was at least as prognostic in patients with MINOCA compared to MI-CAD.

CONCLUSIONS:

Hs-cTnT levels in MINOCA patients are strong and independent predictors of adverse outcome. Consideration of hs-cTnT levels is important for risk assessment of MINOCA patients.

• Authors: Marcus Hjort, Bertil Lindahl, Tomasz Baron, Tomas Jernberg, Per Tornvall, Kai M Eggers
• Journal: American heart journal (Am Heart J) Vol. 200 Pg. 60-66 (06 2018) ISSN: 1097-6744 [Electronic] United States
• PMID: 29898850 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

• Alkaloids
• Biomarkers
• Indoles
• Martefragin A
• Troponin T

Topics

• Aged
• Alkaloids
• Biomarkers (blood)
• Coronary Angiography (methods)
• Coronary Artery Disease (complications, diagnosis, mortality, physiopathology)
• Coronary Stenosis (diagnosis, etiology)
• Coronary Vasospasm (complications, diagnosis)
• Coronary Vessels (diagnostic imaging, pathology, physiopathology)
• Correlation of Data
• Female
• Humans
• Indoles
• Male
• Middle Aged
• Myocardial Infarction (blood, diagnosis, etiology, physiopathology)
• Outcome Assessment, Health Care
• Predictive Value of Tests
• Prognosis
• Registries (statistics & numerical data)
• Risk Factors
• Sweden (epidemiology)
• Troponin T (blood)