Pre-discharge and early post-discharge troponin elevation among patients hospitalized for heart failure with reduced ejection fraction: Findings from the ASTRONAUT trial
| Autor: | Greene SJ, Butler J, Fonarow GC, Subacius HP, Ambrosy AP, Vaduganathan M, Triggiani M, Solomon SD, Lewis EF, Maggioni AP, Böhm M, Chioncel O, Nodari S, Senni M, Zannad F, Gheorghiade M, ASTRONAUT Investigators and Coordinators |
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| Přispěvatelé: | Greene, S, Butler, J, Fonarow, G, Subacius, H, Ambrosy, A, Vaduganathan, M, Triggiani, M, Solomon, S, Lewis, E, Maggioni, A, Böhm, M, Chioncel, O, Nodari, S, Senni, M, Zannad, F, Gheorghiade, M, ASTRONAUT Investigators and, C |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Population Heart failure Outcomes 030204 cardiovascular system & hematology Hospitalization Post-discharge Troponin Cardiology and Cardiovascular Medicine Coronary artery disease 03 medical and health sciences 0302 clinical medicine Risk Factors Interquartile range Cause of Death Internal medicine Troponin I medicine Humans Prospective Studies 030212 general & internal medicine education Aged Outcome education.field_of_study Ejection fraction biology business.industry Hazard ratio Stroke Volume Middle Aged Prognosis medicine.disease Patient Discharge United States Europe Survival Rate biology.protein Cardiology Female business Biomarkers Follow-Up Studies |
| Popis: | Aims: Troponin levels are commonly elevated among patients hospitalized for heart failure (HF), but the prevalence and prognostic significance of early post-discharge troponin elevation are unclear. This study sought to describe the frequency and prognostic value of pre-discharge and post-discharge troponin elevation, including persistent troponin elevation from the inpatient to outpatient settings. Methods and results: The ASTRONAUT trial (NCT00894387; http://www.clinicaltrials.gov) enrolled hospitalized HF patients with ejection fraction ≤40% and measured troponin I prior to discharge (i.e. study baseline) and at 1-month follow-up in a core laboratory (elevation defined as >0.04 ng/mL). This analysis included 1469 (91.0%) patients with pre-discharge troponin data. Overall, 41.5% and 29.9% of patients had elevated pre-discharge [median: 0.09 ng/mL; interquartile range (IQR): 0.06–0.19 ng/mL] and 1-month (median: 0.09 ng/mL; IQR: 0.06–0.15 ng/mL) troponin levels, respectively. Among patients with pre-discharge troponin elevation, 60.4% had persistent elevation at 1 month. After adjustment, pre-discharge troponin elevation was not associated with 12-month clinical outcomes. In contrast, 1-month troponin elevation was independently predictive of increased all-cause mortality [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.18–2.13] and cardiovascular mortality or HF hospitalization (HR 1.28, 95% CI 1.03–1.58) at 12 months. Associations between 1-month troponin elevation and outcomes were similar among patients with newly elevated (i.e. normal pre-discharge) and persistently elevated levels (interaction P ≥ 0.16). The prognostic value of 1-month troponin elevation for 12-month mortality was driven by a pronounced association among patients with coronary artery disease (interaction P = 0.009). Conclusions: In this hospitalized HF population, troponin I elevation was common during index hospitalization and at 1-month follow-up. Elevated troponin I level at 1 month, but not pre-discharge, was independently predictive of increased clinical events at 12 months. Early post-discharge troponin I measurement may offer a practical means of risk stratification and should be investigated as a therapeutic target. |
| Databáze: | OpenAIRE |
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