Serial high-sensitivity troponin-T and risk of heart failure in individuals with suspected acute coronary syndrome

Aims: To investigate the association between serial high-sensitivity cardiac troponin-T (hs-TnT) concentrations and subsequent heart failure in individuals presenting with suspected acute coronary syndrome (ACS). Methods and results: Utilizing Danish nationwide registries, we identified individuals without known heart failure who underwent serial hs-TnT assessment for suspected ACS between 2012 and 2019. Individuals were categorized based on the hs-TnT concentration patterns from the first to the second measurement (normal, rising, persistently elevated, or falling), the extent of hs-TnT concentration change (≤20%, >20 to 50%, or > 50%), and quartiles of peak hs-TnT levels (≤9 ng/l, 10–19 ng/l, 20–263 ng/l, and ≥ 264 ng/l). Standardized absolute and relative risks of incident hospitalization or outpatient contact for heart failure were computed using cause-specific multivariable Cox regression with average treatment effect modeling. Of 26,835 individuals, 38.8% received a discharge diagnosis of myocardial infarction, 5.1% of unstable angina, and 56.1% of suspected myocardial infarction or chest pain. Within the initial 30 days, 1122/26,835 (4.2%) persons received a heart failure diagnosis, with an additional 707/25,085 (2.8%) diagnosed between days 31–365. Subjects with two normal hs-TnT values exhibited the lowest standardized absolute risk (0–30 days: 0.3%; 31–365 days: 0.4%), while those with persistently elevated concentrations demonstrated the highest risk (0–30 days: 6.6%; 31–365 days: 4.3%). Heart failure risk also exhibited a significant, positive association with peak hs-TnT concentration. Conclusions: In individuals presenting with suspected ACS, persistent hs-TnT elevation was associated with the highest risk of subsequent heart failure. A dose-response association was observed between peak hs-TnT concentrations and incident heart failure.