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. 2020 Jun;50(6):e13248.
doi: 10.1111/eci.13248. Epub 2020 May 15.

High-sensitivity cardiac troponin T 30 days all-come mortality in patients with acute heart failure. A Propensity Score-Matching Analysis Based on the EAHFE Registry. TROPICA4 Study

Alex Roset  1 , Javier Jacob  1 , Pablo Herrero-Puente  2 , Aitor Alquézar  3 , Francisco Javier Martín-Sanchez  4 , Pere Llorens  5 , Victor Gil  6 , Irene Cabello  1 , Fernando Richard  7 , Jose Manuel Garrido  8 , Cristina Gil  9 , Lluis Llauger  10 , Desiree Wussler  11 , Christian Mueller  11 , Òscar Miró  6 ; ICA-SEMES Research Group
Collaborators, Affiliations

High-sensitivity cardiac troponin T 30 days all-come mortality in patients with acute heart failure. A Propensity Score-Matching Analysis Based on the EAHFE Registry. TROPICA4 Study

Alex Roset et al. Eur J Clin Invest. 2020 Jun.

Abstract

Background: Acute heart failure (AHF) patients with high troponin levels have a worse prognosis. High-sensitive troponin T (hs-TnT) has been used as a tool to stratify prognosis in many scales but always as a qualitative and not as a quantitative variable.

Objectives: The main objective of this study was to determine the best hs-TnT cut-off for prediction of 30-day all-cause mortality.

Methods: The EAHFE registry, a prospective follow-up cohort of patients with AHF, was analysed. We performed a propensity score analysis of the optimal hs-TnT cut-off point previously determined by receiver operating characteristic (ROC) curve analysis.

Results: Of the 13 791 patients in the EAHFE cohort, we analysed 3190 patients in whom hs-TnT determination was available. The area under the ROC curve for 30-day all-cause mortality was 0.70 (CI95% 0.68 to 0.71; P < .001), establishing an optimal cut-off of hs-TnT of 35 ng/L. The sensitivity and specificity of this cut-off were 76.2 and 55.5%, respectively, with a negative predictive value (NPV) of 95.3%. A propensity score was made with 34 variables showing differences based on the cut-off of 35 ng/L for hs-TnT. In the analysis of the population obtained with the propensity score, patients with hs-TnT > 35 ng/L showed a greater 30-day all-cause mortality, with a HR of 2.95 (CI95% 1.83-4.75; P < .001). External validation reported similar results.

Conclusions: An hs-TnT value of 35 ng/L is an adequate cut-off to evaluate the prediction of 30-day all-cause mortality with a NPV of 95.3%.

Keywords: 30-days mortality; acute heart failure; prognosis; troponin.

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References

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