Serial troponin-I and long-term outcomes in subjects with suspected acute coronary syndrome

BACKGROUND AND AIMS: It is unclear how serial high-sensitivity troponin-I (hsTnI) concentrations affect long-term prognosis in individuals with suspected acute coronary syndrome (ACS).METHODS: Subjects who underwent two hsTnI-measurements (Siemens TnI Flex® Reagent) separated by 1-7 hours, during a first-time hospitalization for myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019, were identified through Danish national registries. Individuals were stratified per their hsTnI-concentration pattern (normal, rising, persistently elevated, or falling) and the magnitude of hsTnI-concentration change (&lt;20%,  &gt; 20 to 50%, or &gt;50% in either direction). We calculated absolute and relative mortality risks standardized to the distributions of risk factors for the entire study population.RESULTS: A total of 20,609 individuals were included of whom 2.3% had died at 30 days, and an additional 4.7% had died at 365 days. The standardized risk of death was highest among persons with a persistently elevated hsTnI-concentration (0-30 days: 8.0%, 31-365 days: 11.1%) and lowest among those with two normal hsTnI-concentrations (0-30 days: 0.5%, 31-365 days: 2.6%). In neither case did relative hsTnI-concentration changes between measurements clearly affect mortality risk. Among persons with a rising hsTnI-concentration pattern, 30-day mortality was higher in subjects with a &gt; 50% rise compared with those with a less pronounced rise (2.2% versus &lt;0.1%).CONCLUSIONS: Among individuals with suspected ACS, those with a persistently elevated hsTnI-concentration consistently had the highest risk of death. In subjects with two normal hsTnI-concentrations, mortality was very low and not affected by the magnitude of change between measurements.</p

Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures : The MORGAM prospective cohort project

To assess whether anthropometric measures (body mass index [BMI], waist-hip ratio [WHR], and estimated fat mass [EFM]) are independently associated with major adverse cardiovascular events (MACE), and to assess their added prognostic value compared with serum total-cholesterol. The study population comprised 109,509 individuals (53% men) from the MORGAM-Project, aged 19–97 years, without established cardiovascular disease, and not on antihypertensive treatment. While BMI was reported in all, WHR and EFM were reported in ∼52,000 participants. Prognostic importance of anthropometric measurements and total-cholesterol was evaluated using adjusted Cox proportional-hazards regression, logistic regression, area under the receiver-operating-characteristic curve (AUCROC), and net reclassification improvement (NRI). The primary endpoint was MACE, a composite of stroke, myocardial infarction, or death from coronary heart disease. Age interacted significantly with anthropometric measures and total-cholesterol on MACE (P ≤ 0.003), and therefore age-stratified analyses (&lt;50 versus ≥ 50 years) were performed. BMI, WHR, EFM, and total-cholesterol were independently associated with MACE (P ≤ 0.003) and resulted in significantly positive NRI when added to age, sex, smoking status, and systolic blood pressure. Only total-cholesterol increased discrimination ability (AUCROC difference; P &lt; 0.001). In subjects &lt; 50 years, the prediction model with total-cholesterol was superior to the model including BMI, but not superior to models containing WHR or EFM, while in those ≥ 50 years, the model with total-cholesterol was superior to all models containing anthropometric variables, whether assessed individually or combined. We found a potential role for replacing total-cholesterol with anthropometric measures for MACE-prediction among individuals &lt; 50 years when laboratory measurements are unavailable, but not among those ≥ 50 years