Any Detectable Cardiac Troponin T Linked to Increased Mortality Risk

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

In patients with chest pain without myocardial infarction, even slightly elevated cardiac troponin T levels are associated with increased long-term mortality risk, suggests a study in the Journal of the American College of Cardiology.

Researchers studied nearly 20,000 patients who presented to a Swedish ED with chest pain and underwent high-sensitivity cardiac troponin T testing. Patients with acute MI or other conditions related to acute troponin elevations were excluded. The 99th percentile cutoff point for the study's troponin assay was 14 ng/L.

During roughly 3 years' follow-up, 7% of the patients died. The annual all-cause mortality rate was lowest (0.5%) among those with troponin levels below 5 ng/L, and then increased with increasing troponin level — reaching 33% at troponin levels of 50 ng/L or higher. After multivariable adjustment, mortality risk was doubled at troponin levels of 5–9 ng/L (versus <5 ng/L) — and was tenfold higher at troponin levels of 50 ng/L or higher.

Dr. Ali Raja of NEJM Journal Watch Emergency Medicine weighs in: "These results are enlightening. It's important to know that elevated high-sensitivity troponin T levels — even when stable — portend a greater risk for 3-year mortality. While not indicative of acute coronary syndrome, these troponin results will allow patients and their physicians to work together to mitigate risk factors for both cardiac and noncardiac death."