Peak high-sensitivity troponin-T concentration and risk of heart failure in patients with suspected acute coronary syndrome

Background Acute coronary syndrome (ACS) is one of the most frequent causes of heart failure. In patients presenting with suspected ACS, it is currently unknown whether peak high-sensitivity troponin-T (hsTnT) is correlated with the short- and long-term risks of subsequent heart failure. Purpose To examine the short- and long-term associations between peak hsTnT and subsequent hospitalization or outpatient contact for heart failure in subjects with suspected ACS. We hypothesized that a higher peak hsTnT would be associated with an increased risk of incident heart failure. Methods Using Danish national registries, we identified persons without known heart failure who underwent two hsTnT measurements (99th percentile: 13.5 ng/l) separated by 1-7 hours, during hospitalization for myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019. Individuals were stratified into quartiles (Q1-Q4) according to their peak hsTnT concentration based on these first two measurements (Q1: <=9 ng/l, Q2: 10-19 ng/l, Q3: 20-263 ng/l, Q4: >=264 ng/l) to explore whether the risk of heart failure was greater with higher hsTnT concentrations. We calculated standardized absolute and relative risks (RR) with 95% confidence intervals (CI) of hospitalization or outpatient contact for heart failure at 0-30 days and 31-365 days after hsTnT measurement using multivariable logistic regression with average treatment effect modeling. Results A total of 26,835 individuals were included; 38.8% were discharged with a diagnosis of myocardial infarction, 5.1% with unstable angina, and 56.1% with observation for suspected myocardial infarction or chest pain. Median age was 64.2 years, 59.5% were male, 18.1% had coronary artery disease, and 7.2% had undergone prior revascularization. A total of 1,122 individuals received a diagnosis of heart failure within the first 30 days and an additional 707 were diagnosed from days 31-365. The association between hsTnT and heart failure risk is shown in Figure 1 using spline curves. The absolute risk of heart failure increased in a stepwise fashion with higher hsTnT concentrations within both 30 days (Q1: 0.18%; Q2: 0.56%; Q3: 3.55%; Q4: 12.42%) and 31-365 days (Q1: 0.38%; Q2: 0.75%; Q3: 2.52%; Q4: 7.66%). There was a significantly increased risk of heart failure in groups with higher peak hsTnT, within 30 days (Q4 vs. Q1, RR: 68.79, 95% CI 25.56 to 112.02; Q3 vs. Q1, RR: 19.66, 95% CI 7.15-32.17) and 31-365 days (Q4 vs. Q1, RR: 19.86, 95% CI 10.49 to 29.23; Q3 vs. Q1, RR: 6.53, 95% CI 3.34 to 9.71). Absolute and relative risks of heart failure at days 0-30 and 31-365 according to peak high-sensitivity troponin-T are shown in Figure 2. Conclusions Among individuals with suspected ACS, those with higher peak hsTnT concentrations had higher risks of subsequent hospitalization or outpatient contact for heart failure, within 30 days and at 31-365 days.