Mortality at 5 Years Among Very Elderly Patients Undergoing High Sensitivity Troponin T Testing for Suspected Acute Coronary Syndromes

Aisha Etaher; Tuan L Nguyen; Yousef M Saad; Steven Frost; Ian Ferguson; Craig P Juergens; Derek Chew; John K French

doi:10.1016/j.hlc.2020.02.015

Mortality at 5 Years Among Very Elderly Patients Undergoing High Sensitivity Troponin T Testing for Suspected Acute Coronary Syndromes

Heart Lung Circ. 2020 Nov;29(11):1696-1703. doi: 10.1016/j.hlc.2020.02.015. Epub 2020 Apr 14.

Authors

Aisha Etaher¹, Tuan L Nguyen², Yousef M Saad¹, Steven Frost³, Ian Ferguson⁴, Craig P Juergens¹, Derek Chew⁵, John K French⁶

Affiliations

¹ Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; The University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia.
² Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; The University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia; Department of Emergency, Liverpool Hospital, Sydney, NSW, Australia.
³ Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Western Sydney University, Sydney, NSW, Australia.
⁴ The University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia; Department of Emergency, Liverpool Hospital, Sydney, NSW, Australia.
⁵ College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia.
⁶ Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; The University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Sydney, NSW, Australia. Electronic address: j.french@unsw.edu.au.

PMID: 32439246
DOI: 10.1016/j.hlc.2020.02.015

Abstract

Background: Patients aged ≥80 years old often present to Emergency Departments (ED) with symptoms potentially due to an acute coronary syndrome (ACS). This study aimed to evaluate associations between baseline level(s) of high sensitivity troponin T (HsTnT), adjudicated diagnoses and outcomes.

Methods: Consecutive patients aged ≥80 years were studied, who presented to the ED at Liverpool Hospital, NSW, Australia during the 4 months period March to June 2014 (inclusive) with symptoms suggestive of an ACS, and who had at least one HsTnT assay performed. Diagnoses were based on the fourth universal definition of MI (myocardial infarction) including type-1 MI, type-2 MI, acute myocardial injury, chronic myocardial injury; the rest were termed "other diagnoses". Patients were categorised by baseline HsTnT levels 1) ≤14 ng/L, 2) 15-29 ng/L, 3) 30-49 ng/L and 4) ≥50 ng/L.

Results: Of 2,773 patients screened, 545 were aged ≥80 years (median age 85 [IQR 82-88]); median follow-up was 32 months (IQR 5-56). The respective rates of adjudicated diagnoses were type-I MI 3.1%, type-2 MI 13%, acute myocardial injury 9.5%, chronic myocardial injury 56% and 18.6% had other diagnoses. Mortality rates increased, irrespective of adjudicated diagnoses with increasing HsTnT levels (ng/L): 17% (16/96) for ≤14; 35% (67/194) for 15-29; 51% (65/127) for 30-49; and 64% (82/128) for ≥50 ng/L; log rank p≤0.001. On multi-variable analyses, after adjusting for potential confounding factors including age, hypertension, chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD), MI type was not associated with late mortality.

Conclusions: Among patients aged ≥80 years higher HsTnT levels, irrespective of adjudicated diagnoses, were associated with increased mortality. Most very elderly patients presenting with symptoms suggestive of an ACS undergoing HsTnT testing in EDs had elevated levels most commonly due to chronic myocardial injury. Whether any interventions can modify outcomes require prospective evaluation.

Keywords: High sensitivity troponin T; Late mortality; Myocardial injury; Type-2 MI; Very elderly.

MeSH terms

Acute Coronary Syndrome / blood
Acute Coronary Syndrome / diagnosis
Acute Coronary Syndrome / mortality*
Aged, 80 and over
Biomarkers / blood
Female
Follow-Up Studies
Humans
Male
New South Wales / epidemiology
Prospective Studies
Reproducibility of Results
Survival Rate / trends
Time Factors
Troponin T / blood*

Substances

Biomarkers
Troponin T