What is the prognostic value of cardiac troponin?

Updated: Jul 30, 2021
  • Author: Kamal (Komo) Gursahani, MD, MBA; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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In addition to its use in the diagnosis of MI, an elevated troponin level can identify patients at high risk for major adverse cardiac events (MACE). [33, 34] Specifically, data from a meta-analysis indicated that an elevated troponin level in patients without ST-segment elevation is associated with a nearly four-fold increase in the cardiac mortality rate. [35] In patients without ST-segment elevation who were being considered for thrombolytic therapy, initial TnI levels on admission correlated with mortality at 6 weeks, but CK-MB levels were not predictive of adverse cardiac events and had no prognostic value. [33]

Other studies revealed that an elevated troponin level at baseline was an independent predictor of mortality, even in patients with chest pain and acute MI with ST-segment elevation (STEMI) who were eligible for reperfusion therapy. [36, 37]

Data from the ARTEMIS study, comprising 1137 diabetic patients with stable coronary artery disease (CAD) and 649 normoglycemic patients, found that high levels (≥14 ng/L) of hs-TnT was an independent strong predictor of cardiac death or hospitalization for heart failure in patients with diabetes and CAD (as were B-type natriuretic peptide, hs-C-reactive protein [hs-CRP], and soluble suppressor of tumorigenicity-2 [sST2] in a multivariate analysis). [38] In the nondiabetic group, only hs-CRP and sST2 were predictive for these outcomes.

Data from the Acute Decompensated Heart Failure National Registry (ADHERE) involving information from 23,696 patients hospitalized with acute heart failure showed that increased levels of troponin and creatinine were the strongest predictors of in-hospital worsening heart failure. [39]

The TIMI IIIB, GUSTO IIa, GUSTO IV ACS, and FRISC trials all demonstrated a direct correlation between the level of TnI or TnT and the mortality and adverse cardiac event rate in ACS. [33, 36, 40, 41, 42]

Cardiac troponin levels have also been associated with higher mortality in patients with pulmonary embolism, presumably due to their significance as markers of right ventricular strain, particularly in normotensive patients. [27]

More recently, elevated high-sensitivity troponin T levels in patients hospitalized with coronavirus disease 2019 (COVID-19) may indicate a higher risk for in-hospital mortality. [43, 44]

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