Clinical and prognostic implications of high-sensitivity cardiac troponin T concentrations in type 2 non-ST elevation myocardial infarction

K M Eggers; T Baron; A Gard; B Lindahl

doi:10.1016/j.ijcha.2022.100972

Clinical and prognostic implications of high-sensitivity cardiac troponin T concentrations in type 2 non-ST elevation myocardial infarction

Int J Cardiol Heart Vasc. 2022 Feb 12:39:100972. doi: 10.1016/j.ijcha.2022.100972. eCollection 2022 Apr.

Authors

K M Eggers¹, T Baron¹, A Gard¹, B Lindahl²

Affiliations

¹ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
² Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.

Abstract

Background: While the clinical importance of cardiac troponin is well-known in type 1 myocardial infarction (MI), evidence on this topic in type 2 MI is limited. We assessed the clinical and prognostic implications of high-sensitivity cardiac troponin (hs-cTnT) concentrations in a large sample of patients with type 2 MI.

Methods: Retrospective registry-based cohort study (SWEDEHEART) including 4607 patients with type 2 MI and 43,405 patients with type 1 MI, used for comparisons. Patients with ST-elevation MI were excluded. Multivariable-adjusted regressions were applied to investigate the associations of hs-cTnT concentrations (highest measured value during each hospitalization) with clinical variables and prognosis during a median follow-up of up to 1.9 years.

Results: Hs-cTnT concentrations (median 264 [25th, 75th percentiles 112-654] ng/L) were significantly associated with various cardiovascular risk factors and comorbidities in type 2 non-ST elevation MI (NSTEMI) but only weakly with the underlying triggering condition. Most of these findings including the magnitude of hs-cTn release were similar to type 1 NSTEMI. Hs-cTnT (ln) independently predicted all-cause mortality (hazard ratio 1.13 [95% confidence interval 1.09-1.17]) and major adverse events (hazard ratio 1.13 [95% confidence interval 1.10-1.17]) in type 2 NSTEMI, similar as for type 1 NSTEMI according to interaction analysis. The associations of hs-cTnT (ln) with poor prognosis tended to be stronger in type 2 NSTEMI patients without known cardiovascular disease.

Conclusions: Hs-cTnT concentrations independently predict adverse outcome in type 2 NSTEMI. The similarities to type 1 NSTEMI however, are striking and emphasize the difficulty to distinguish both MI types.

Keywords: CAD, Coronary artery disease; CVD, Cardiovascular disease; High-sensitivity cardiac troponin T; ICD-10-CM, International Classification of Diseases, 10th revision, Clinical Modification; MAE, Major adverse events; MI, Myocardial infarction; NSTEMI, Non-ST elevation myocardial infarction; Risk prediction; SWEDEHEART, Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies; TOTAL-AMI, Tailoring Of Treatment in All comers with Acute Myocardial Infarction; Type 2 myocardial infarction; cTn, Cardiac troponin; hs-cTnT, High-sensitivity cardiac troponin T.