Abstract
Background: The prognostic value of cardiac troponins in revascularized patients with myocardial infarction (MI) is uncertain. This study examined the relationship between peak troponin levels and adverse outcomes in a revascularized cohort from the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS).
Methods: MENZACS enrolled patients with a first-time acute coronary syndrome from 2015-2019. Peak high sensitivity troponin was standardized by dividing the observed peak troponin by the upper limit of normal. The primary outcome was a composite of all-cause death or cardiovascular readmission, determined through national datasets. Troponin's relationship with outcomes was analysed using penalized spline Cox regression.
Results: Among 1645 revascularized patients (81% male, mean age 61, 74% European, 14% Māori, 5% Pacific, 5% Indian, 3% Other; 46% ST-elevation MI, 54% non-ST-elevation MI), higher peak troponin was associated with male sex, ST-elevation MI, current smoking, and elevated N-terminal pro-B-type natriuretic peptide levels. Over a median of 4.9 years, 402 (24%) people experienced the primary outcome. Peak troponin levels were not significantly associated with this outcome.
Conclusion: In this revascularized cohort surviving a first-time MI, the magnitude of peak troponin elevation was not associated with all-cause death or cardiovascular readmission.