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Troponin T to Identify Acute HF Patients at Lower Risk for Adverse Outcomes
Study Questions:
What is the prognostic value of a baseline high-sensitivity troponin T (hs-TnT) value ≤99th percentile upper reference limit (0.014 mg/L [‘low hs-TnT’]) in identifying patients with acute heart failure (HF) at low risk for adverse outcomes?
Methods:
A post hoc analysis was conducted from the RELAX-AHF trial, which randomized patients within 16 hours of presentation who had systolic blood pressure >125 mm Hg, mild to moderate renal impairment, and N-terminal pro–brain natriuretic peptide ≥1600 ng/L to serelaxin versus placebo. Linear regression models for continuous endpoints and Cox models for time-to-event endpoints were used.
Results:
Of the 1,076 patients with available baseline hs-TnT values, 107 (9.9%) had low hs-TnT. No cardiovascular (CV) deaths through day 180 were observed in the low hs-TnT group compared with 79 CV deaths (7.3%) in patients with higher hs-TnT. By univariate analyses, low hs-TnT was associated with lower risk for all five primary outcomes: 1) days alive and out of the hospital by day 60; 2) CV death or rehospitalization for HF or renal failure by day 60; 3) length of stay; 4) worsening HF through day 5; and 5) CV death through day 180. After multivariate adjustment, only 180-day CV mortality remained significant (hazard ratio, 0.0; 95% confidence interval, 0.0-0.736; p = 0.0234; C-index = 0.838 [95% CI, 0.798-0.878]).
Conclusions:
The authors concluded that low baseline hs-TnT may identify patients with acute HF at very low risk for CV mortality.
Perspective:
This post hoc analysis of the RELAX-AHF trial reports that patients with baseline hs-TnT values below the 99th percentile (low hs-TnT) were at significantly lower risk for CV death. Furthermore, low hs-TnT remained significant after adjustment for various known markers of risk. This appears to suggest that patients with signs and symptoms of acute HF, without evidence of myocardial injury as measured by hs-TnT assay, are at very low risk for CV death. Identifying even a small fraction of patients safe for discharge, coupled with robust transitions of care, would result in a significant decrease in the absolute number of hospitalized patients and potential large cost savings.
Keywords: Biomarkers, Blood Pressure, Heart Failure, Length of Stay, Natriuretic Peptide, Brain, Outcome Assessment, Health Care, Prognosis, Relaxin, Renal Insufficiency, Risk, Troponin T
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