Prognostic value of troponins in acute coronary syndrome depends upon patient age

Phyo Kyaw Myint, Chun Shing Kwok, Max O Bachmann, Susan Stirling, Lee Shepstone, M Justin Zaman

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: This study aims to determine whether the prognostic significance of troponins in acute coronary syndrome in predicting mortality varies by age, and if so, to what extent when other prognostic indicators are considered.

METHODS: We analysed Myocardial Ischemia National Audit Project registry data collected between January 2006 and December 2010 and followed up this cohort for all-cause mortality until August 2011. Relationships between peak troponin levels (types I and T) and time to death in different age groups, and between age and time to death at different troponin levels were investigated using multiple variable adjusted Cox regression models.

RESULTS: Of the 322 617 patients with acute coronary syndromes included, a third (n=106 365, 33%) died during 695 334 person-years of follow-up. Within each troponin category, older age was associated with a higher mortality even in those with a troponin <0.01 ng/mL for both troponin types (HR ~10-12 in ≥85 years cf. HR of 1.0 in <65 years). The relative potency of an elevated troponin to predict an adverse outcome compared with a low troponin attenuated with increased age (for troponin I ≥15.0 compared with troponin I <0.01 in age <65, adjusted HR 2.41 (95% CI 1.80 to 3.24); age ≥85 HR 2.01 (1.62 to 2.52)). Similar but less consistent results were observed with troponin T elevation at the higher levels.

CONCLUSIONS: Clinicians should interpret the prognostic value of troponin taking into account the patient's age.

Original languageEnglish
Pages (from-to)1583-1590
Number of pages8
JournalHeart
Volume100
Issue number20
Early online date26 Jun 2014
DOIs
Publication statusPublished - Oct 2014

Fingerprint

Troponin
Acute Coronary Syndrome
Troponin I
Troponin T
Mortality
Proportional Hazards Models
Myocardial Ischemia
Registries
Age Groups

Keywords

  • Acute Coronary Syndrome
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Biological Markers
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Troponin I
  • Troponin T

Cite this

Myint, P. K., Kwok, C. S., Bachmann, M. O., Stirling, S., Shepstone, L., & Zaman, M. J. (2014). Prognostic value of troponins in acute coronary syndrome depends upon patient age. Heart, 100(20), 1583-1590. https://doi.org/10.1136/heartjnl-2014-305533

Prognostic value of troponins in acute coronary syndrome depends upon patient age. / Myint, Phyo Kyaw; Kwok, Chun Shing; Bachmann, Max O; Stirling, Susan; Shepstone, Lee; Zaman, M Justin.

In: Heart, Vol. 100, No. 20, 10.2014, p. 1583-1590.

Research output: Contribution to journalArticle

Myint, PK, Kwok, CS, Bachmann, MO, Stirling, S, Shepstone, L & Zaman, MJ 2014, 'Prognostic value of troponins in acute coronary syndrome depends upon patient age', Heart, vol. 100, no. 20, pp. 1583-1590. https://doi.org/10.1136/heartjnl-2014-305533
Myint, Phyo Kyaw ; Kwok, Chun Shing ; Bachmann, Max O ; Stirling, Susan ; Shepstone, Lee ; Zaman, M Justin. / Prognostic value of troponins in acute coronary syndrome depends upon patient age. In: Heart. 2014 ; Vol. 100, No. 20. pp. 1583-1590.
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abstract = "OBJECTIVE: This study aims to determine whether the prognostic significance of troponins in acute coronary syndrome in predicting mortality varies by age, and if so, to what extent when other prognostic indicators are considered.METHODS: We analysed Myocardial Ischemia National Audit Project registry data collected between January 2006 and December 2010 and followed up this cohort for all-cause mortality until August 2011. Relationships between peak troponin levels (types I and T) and time to death in different age groups, and between age and time to death at different troponin levels were investigated using multiple variable adjusted Cox regression models.RESULTS: Of the 322 617 patients with acute coronary syndromes included, a third (n=106 365, 33{\%}) died during 695 334 person-years of follow-up. Within each troponin category, older age was associated with a higher mortality even in those with a troponin <0.01 ng/mL for both troponin types (HR ~10-12 in ≥85 years cf. HR of 1.0 in <65 years). The relative potency of an elevated troponin to predict an adverse outcome compared with a low troponin attenuated with increased age (for troponin I ≥15.0 compared with troponin I <0.01 in age <65, adjusted HR 2.41 (95{\%} CI 1.80 to 3.24); age ≥85 HR 2.01 (1.62 to 2.52)). Similar but less consistent results were observed with troponin T elevation at the higher levels.CONCLUSIONS: Clinicians should interpret the prognostic value of troponin taking into account the patient's age.",
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AU - Myint, Phyo Kyaw

AU - Kwok, Chun Shing

AU - Bachmann, Max O

AU - Stirling, Susan

AU - Shepstone, Lee

AU - Zaman, M Justin

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N2 - OBJECTIVE: This study aims to determine whether the prognostic significance of troponins in acute coronary syndrome in predicting mortality varies by age, and if so, to what extent when other prognostic indicators are considered.METHODS: We analysed Myocardial Ischemia National Audit Project registry data collected between January 2006 and December 2010 and followed up this cohort for all-cause mortality until August 2011. Relationships between peak troponin levels (types I and T) and time to death in different age groups, and between age and time to death at different troponin levels were investigated using multiple variable adjusted Cox regression models.RESULTS: Of the 322 617 patients with acute coronary syndromes included, a third (n=106 365, 33%) died during 695 334 person-years of follow-up. Within each troponin category, older age was associated with a higher mortality even in those with a troponin <0.01 ng/mL for both troponin types (HR ~10-12 in ≥85 years cf. HR of 1.0 in <65 years). The relative potency of an elevated troponin to predict an adverse outcome compared with a low troponin attenuated with increased age (for troponin I ≥15.0 compared with troponin I <0.01 in age <65, adjusted HR 2.41 (95% CI 1.80 to 3.24); age ≥85 HR 2.01 (1.62 to 2.52)). Similar but less consistent results were observed with troponin T elevation at the higher levels.CONCLUSIONS: Clinicians should interpret the prognostic value of troponin taking into account the patient's age.

AB - OBJECTIVE: This study aims to determine whether the prognostic significance of troponins in acute coronary syndrome in predicting mortality varies by age, and if so, to what extent when other prognostic indicators are considered.METHODS: We analysed Myocardial Ischemia National Audit Project registry data collected between January 2006 and December 2010 and followed up this cohort for all-cause mortality until August 2011. Relationships between peak troponin levels (types I and T) and time to death in different age groups, and between age and time to death at different troponin levels were investigated using multiple variable adjusted Cox regression models.RESULTS: Of the 322 617 patients with acute coronary syndromes included, a third (n=106 365, 33%) died during 695 334 person-years of follow-up. Within each troponin category, older age was associated with a higher mortality even in those with a troponin <0.01 ng/mL for both troponin types (HR ~10-12 in ≥85 years cf. HR of 1.0 in <65 years). The relative potency of an elevated troponin to predict an adverse outcome compared with a low troponin attenuated with increased age (for troponin I ≥15.0 compared with troponin I <0.01 in age <65, adjusted HR 2.41 (95% CI 1.80 to 3.24); age ≥85 HR 2.01 (1.62 to 2.52)). Similar but less consistent results were observed with troponin T elevation at the higher levels.CONCLUSIONS: Clinicians should interpret the prognostic value of troponin taking into account the patient's age.

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