Key result
High baseline hs-cTnT (upper tertile) was independently associated with increased all-cause mortality in elderly inpatients without acute cardiovascular events (HR 3.29; 95% CI 1.85-5.85).
Why the study?
Although elevated hs-cTnT and NT-proBNP confer high risk of adverse outcomes in the elderly, their comparative value for predicting long-term mortality in elderly inpatients hospitalized without acute cardiovascular events required investigation.
Do baseline hs-cTnT and NT-proBNP levels predict long-term all-cause mortality in elderly inpatients without acute cardiovascular events?
Cohort (n=715)
Do baseline hs-cTnT and NT-proBNP levels predict long-term all-cause mortality in elderly inpatients without acute cardiovascular events?
Hazard Ratio: 3.29 (95% CI 1.85–5.85)
High-sensitivity cardiac troponin T, but not NT-proBNP, is an independent predictor of long-term all-cause mortality in elderly inpatients without acute cardiovascular events.
May inform risk stratification in stable elderly inpatients; hypothesis-generating and requires prospective validation before clinical adoption.
BACKGROUND: Studies have shown that increases in low-level high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) in the elderly population lead to high risk of adverse clinical outcomes, such as mortality. In this study, associations between the two biomarkers and long-term mortality in elderly patients hospitalized for medical conditions other than acute cardiovascular events were investigated. A comparison of the predictive value of hs-cTnT and NT-proBNP for all-cause mortality was conducted. METHODS: A cohort of 715 elderly inpatients free of acute cardiovascular events was initially recruited. Based on tertiles of baseline hs-cTnT and NT-proBNP levels, the elderly were arranged into low, middle, and high groups. The mortality of each group was observed and the predictive values of hs-cTnT and NT-proBNP compared. Additionally, all-cause mortality was analyzed for hs-cTnT and NT-proBNP combined. RESULTS: There were 135 (18.9%) all-cause mortality cases identified during follow-up (median 47 months). The upper tertile of hs-cTnT was significantly associated with an increased risk of mortality (HR 3.29, 95% CI 1.85-5.85), even after adjustment for potential confounders. However, there were no significant differences observed in mortality rates among the three NT-proBNP groups after adjustment for potential confounders (HR 1.77, 95% CI 0.83-3.17). Compared to NT-proBNP, hs-cTnT was a better predictor of mortality, as area under curves for hs-cTnT and NT-proBNP at 60 months were 0.712 (95% CI 0.616-0.809) and 0.585 (95% CI 0.483-0.6871), respectively. Also, the combination of the two cardiac biomarkers did not render a better predictive value for mortality than hs-cTnT alone. CONCLUSION: Unlike hs-cTnT, baseline NT-proBNP levels failed to show an independent association with all-cause mortality in hospitalized elderly without acute cardiovascular events. hs-cTnT provided significant prognostic value for mortality in the study cohort.
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Chen et al. (2018) conducted a cohort in elderly inpatients free of acute cardiovascular events (n=715). High-sensitivity cardiac troponin T (hs-cTnT) upper tertile vs. Lower tertiles of hs-cTnT was evaluated on all-cause mortality (HR 3.29, 95% CI 1.85-5.85). High baseline hs-cTnT (upper tertile) was independently associated with increased all-cause mortality in elderly inpatients without acute cardiovascular events (HR 3.29; 95% CI 1.85-5.85).
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