Mortality at 5 Years Among Very Elderly Patients Undergoing High Sensitivity Troponin T Testing for Suspected Acute Coronary Syndromes

• Published in: Heart, lung & circulation lung & circulation, 2020-11, Vol.29 (11), p.1696-1703
• Main Authors: Etaher, Aisha, Nguyen, Tuan L., Saad, Yousef M., Frost, Steven, Ferguson, Ian, Juergens, Craig P., Chew, Derek, French, John K.
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Aged, 80 and over; Biomarkers - blood; Female; Follow-Up Studies; High sensitivity troponin T; Humans; Late mortality; Male; Myocardial injury; New South Wales - epidemiology; Prospective Studies; Reproducibility of Results; Survival Rate - trends; Time Factors; Troponin T - blood; Type-2 MI; Very elderly
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2020.02.015

Patients aged ≥80 years old often present to Emergency Departments (ED) with symptoms potentially due to an acute coronary syndrome (ACS). This study aimed to evaluate associations between baseline level(s) of high sensitivity troponin T (HsTnT), adjudicated diagnoses and outcomes. Consecutive patients aged ≥80 years were studied, who presented to the ED at Liverpool Hospital, NSW, Australia during the 4 months period March to June 2014 (inclusive) with symptoms suggestive of an ACS, and who had at least one HsTnT assay performed. Diagnoses were based on the fourth universal definition of MI (myocardial infarction) including type-1 MI, type-2 MI, acute myocardial injury, chronic myocardial injury; the rest were termed “other diagnoses”. Patients were categorised by baseline HsTnT levels 1) ≤14 ng/L, 2) 15–29 ng/L, 3) 30–49 ng/L and 4) ≥50 ng/L. Of 2,773 patients screened, 545 were aged ≥80 years (median age 85 [IQR 82–88]); median follow-up was 32 months (IQR 5–56). The respective rates of adjudicated diagnoses were type-I MI 3.1%, type-2 MI 13%, acute myocardial injury 9.5%, chronic myocardial injury 56% and 18.6% had other diagnoses. Mortality rates increased, irrespective of adjudicated diagnoses with increasing HsTnT levels (ng/L): 17% (16/96) for ≤14; 35% (67/194) for 15–29; 51% (65/127) for 30–49; and 64% (82/128) for ≥50 ng/L; log rank p≤0.001. On multi-variable analyses, after adjusting for potential confounding factors including age, hypertension, chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD), MI type was not associated with late mortality. Among patients aged ≥80 years higher HsTnT levels, irrespective of adjudicated diagnoses, were associated with increased mortality. Most very elderly patients presenting with symptoms suggestive of an ACS undergoing HsTnT testing in EDs had elevated levels most commonly due to chronic myocardial injury. Whether any interventions can modify outcomes require prospective evaluation.