Raised high sensitivity Troponin T (Hs-TnT) assays in non-ACS medical admissions and long term outcomes

Aim To determine mortality outcomes associated with raised high-sensitivity serum Troponin T (Hs-TnT), >14ng/L, for patients presenting to the acute medical unit without acute coronary syndrome (ACS). Design Observational study. Methods We reviewed all serum Hs-TnT tests completed over 21 years in our large university hospital. We compared the results to the primary outcome of 30-day mortality and the secondary outcome of post-discharge survival. The correlation between abnormally raised Hs-TnT, >14ng/L, and mortality was assessed with logistic regression analysis using logarithmic transformation of Hs-TnT and other clinical variables. The relationship between post-discharge survival and Hs-TnT was examined with either Kaplan-Meier or Cox proportionate hazard models. Results There were 115,908 emergency medical admissions, and Hs-TnT was completed for 23.5% (n=27254). Patients with Hs-TnT testing completed had 5.5 times the likelihood of in-hospital mortality within 30 days of admission [95% CI 5.1, 6.9]. There was a significantly increased likelihood of mortality for those with Hs-TnT >50ng/L [95% CI 10.1, 12.0] compared to those with normal Hs-TnT levels [95%CI 5.1, 35.3%]. 68,044 patients were followed after hospital discharge, with a mortality rate of 8% (n=5,447) over a mean observation time of 27 months. We noted a trend towards decreased Hs-TnT testing for medical admissions over 21 years; 29.5% to 20%. Conclusion Patients admitted with non-ACS diagnoses who had serum Hs-TnT test had a significantly increased risk of mortality with serum Hs-TnT concentrations >50ng/L demonstrating statistically significant increased mortality rates at 30-days compared to those with Hs-TnT >14ng/L.