Initial versus peak high-sensitivity troponin T for risk stratification in STEMI

Background High-sensitivity (hs) cardiac troponin assays detect lower troponin concentrations, but the prognostic significance of these values in STEMI is uncertain. Methods We studied 5,136 STEMI patients. Initial and peak hs-cardiac troponin T (hs-cTnT) levels were stratified into deciles. Logistic regression assessed the association between hs-cTnT deciles and in-hospital mortality, using decile 1 (initial) and decile 2 (peak) as references. Results Each one-decile increase in initial hs-cTnT was associated with a 25% higher odds of in-hospital mortality (OR 1.25; 95% CI 1.17–1.33; p<0.001). Mortality increased from 0.58% in decile 1 to 7.8% in decile 10, with decile 10 conferring >15-fold higher odds of death (OR 15.22; 95% CI 4.70–49.72; p<0.001). Peak hs-cTnT showed a bell-shaped association with mortality; decile 10 was associated with a sevenfold higher odds of death versus decile 2 (OR 7.01; 95% CI 3.43–14.33; p<0.001), while higher mortality in decile 1 likely reflected early death before peak troponin levels. Conclusion Initial hs-cTnT shows a strong dose–response relationship with in-hospital mortality in STEMI. Very high peak hs-cTnT identifies a particularly high-risk subgroup that may benefit from intensified monitoring and management.