The relative potency of an elevated troponin to predict all-cause mortality compared with a low troponin attenuated with increased age (adjusted HR 2.41 in age <65 vs HR 2.01 in age ≥85).
Cohort (n=322,617)
Yes
Does the prognostic value of elevated troponin for predicting mortality in acute coronary syndrome vary by patient age?
The prognostic value of elevated troponin for predicting mortality in acute coronary syndrome is attenuated in older patients, indicating that age must be considered when interpreting troponin levels.
Effect estimate: HR 2.41 (95% CI 1.80 to 3.24)
OBJECTIVE: This study aims to determine whether the prognostic significance of troponins in acute coronary syndrome in predicting mortality varies by age, and if so, to what extent when other prognostic indicators are considered. METHODS: We analysed Myocardial Ischemia National Audit Project registry data collected between January 2006 and December 2010 and followed up this cohort for all-cause mortality until August 2011. Relationships between peak troponin levels (types I and T) and time to death in different age groups, and between age and time to death at different troponin levels were investigated using multiple variable adjusted Cox regression models. RESULTS: Of the 322 617 patients with acute coronary syndromes included, a third (n=106 365, 33%) died during 695 334 person-years of follow-up. Within each troponin category, older age was associated with a higher mortality even in those with a troponin <0.01 ng/mL for both troponin types (HR ~10-12 in ≥85 years cf. HR of 1.0 in <65 years). The relative potency of an elevated troponin to predict an adverse outcome compared with a low troponin attenuated with increased age (for troponin I ≥15.0 compared with troponin I <0.01 in age <65, adjusted HR 2.41 (95% CI 1.80 to 3.24); age ≥85 HR 2.01 (1.62 to 2.52)). Similar but less consistent results were observed with troponin T elevation at the higher levels. CONCLUSIONS: Clinicians should interpret the prognostic value of troponin taking into account the patient's age.
Myint et al. (Thu,) conducted a cohort in Acute coronary syndrome (n=322,617). Elevated troponin levels (types I and T) vs. Low troponin levels (<0.01 ng/mL) was evaluated on All-cause mortality (HR 2.41, 95% CI 1.80 to 3.24). The relative potency of an elevated troponin to predict all-cause mortality compared with a low troponin attenuated with increased age (adjusted HR 2.41 in age <65 vs HR 2.01 in age ≥85).