Key result
Normal admission troponin in STEMI linked to ~16% greater odds of survival vs elevated levels.
Why the study?
Small studies showed STEMI patients with normal admission troponin have lower short-term mortality than those with higher values, but long-term prognosis in larger cohorts remained to be evaluated.
Do normal troponin levels on admission predict better survival in STEMI patients compared to elevated troponin levels?
Do normal troponin levels on admission predict better survival in STEMI patients compared to elevated troponin levels?
In STEMI patients, normal troponin levels on admission are associated with significantly better short- and long-term survival compared to elevated troponin levels.
Normal admission troponin identifies lower-risk STEMI; extends prior short-term observations to 5 years but leaves practice change open.
Ischemic heart disease is one of the leading causes of morbidity and mortality worldwide. Since the beginning of the 2000s, troponin has been the preferred biomarker for diagnosis of myocardial infarction. Small studies have shown that patients with ST-elevation myocardial infarction (STEMI) and normal troponin values on admission have a lower short-term mortality rate compared to those with higher values. We compared the outcomes of STEMI patients with normal troponin levels (below rule-in for MI cut-off) on admission with those with elevated troponin values (above rule-in for MI cut-off). Methods: We used the Israeli Ministry of Health database (‘KINERET") and obtained the mortality data from the ‘Israeli population registry’. All patients with STEMI admitted to the Cardiovascular Divisions at medical centers between 2016 and 2024 were included in this analysis. The cut-off Troponin levels were determined by ESC rule-in for MI criteria (52 ng/ml for Troponin T and 64 ng/ml for Troponin I). We used a multivariable logistic regression model to adjust for possible confounders. Results: A total of 8394 patients (76% male, mean age 68.3±13 years) were included in this study. The patients' initial troponin was elevated at 63.5% (n=5330). The 1-year (94.7%) and 5-year (87.7%) survival were significantly higher in the normal range troponin group compared with the elevated troponin group (84.9% and 75.7% respectively; n=3064; P<0.01; Figure1). In a multivariable analysis, after adjusting for possible confounding variables (age, gender, hypertension, diabetes, previous heart failure, chronic kidney disease) patients with elevated troponin levels still face significantly worse outcomes (adjusted OR=1.16±0.01; P<0.01; Figure 2). Conclusion: This is the largest study to evaluate the long-term prognosis of STEMI patients with normal troponin levels on admission. We found that STEMI patients with normal Troponin levels on admission have better short and long-term prognoses compared with STEMI patients with elevated troponin levels on admission.
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Stoler et al. (2025) studied this question. STEMI patients with normal troponin on admission had higher 1-year (94.7% vs 84.9%) and 5-year survival (87.7% vs 75.7%) than those with elevated troponin, adjusted OR=1.16.
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