Use of High-Sensitivity Troponin T to Identify Patients With Acute Heart Failure at Lower Risk for Adverse Outcomes. An Exploratory Analysis From the RELAX-AHF Trial

Peter S. Pang, John R. Teerlink, Adriaan A. Voors, Piotr Ponikowski, Barry H. Greenberg, Gerasimos Filippatos, G. Michael Felker, Beth A. Davison, Gad Cotter, Joshua Kriger, Margaret F. Prescott, Tsushung A. Hua, Thomas Severin, Marco Metra

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

Objectives: The aim of this study was to determine if a baseline high-sensitivity troponin T (hsTnT) value ≤99th percentile upper reference limit (0.014 μg/l ["low hsTnT"]) identifies patients at low risk for adverse outcomes. Background: Approximately 85% of patients who present to emergency departments with acute heart failure are admitted. Identification of patients at low risk might decrease unnecessary admissions. Methods: A post-hoc analysis was conducted from the RELAX-AHF (Serelaxin, Recombinant Human Relaxin-2, for Treatment of Acute Heart Failure) trial, which randomized patients within 16 h of presentation who had systolic blood pressure >125 mm Hg, mild to moderate renal impairment, and N-terminal pro-brain natriuretic peptide ≥1,600 ng/l to serelaxin versus placebo. Linear regression models for continuous endpoints and Cox models for time-to-event endpoints were used. Results: Of the 1,076 patients with available baseline hsTnT values, 107 (9.9%) had low hsTnT. No cardiovascular (CV) deaths through day 180 were observed in the low-hsTnT group compared with 79 CV deaths (7.3%) in patients with higher hsTnT. By univariate analyses, low hsTnT was associated with lower risk for all 5 primary outcomes: 1) days alive and out of the hospital by day 60; 2) CV death or rehospitalization for heart failure or renal failure by day 60; 3) length of stay; 4) worsening heart failure through day 5; and 5) CV death through day 180. After multivariate adjustment, only 180-day CV mortality remained significant (hazard ratio: 0.0; 95% confidence interval: 0.0 to 0.736; p = 0.0234; C-index = 0.838 [95% confidence interval: 0.798 to 0.878]). Conclusions: No CV deaths through day 180 were observed in patients with hsTnT levels ≤0.014 μg/l despite high N-terminal pro-brain natriuretic peptide levels. Low baseline hsTnT may identify patients with acute heart failure at very low risk for CV mortality.

Original languageEnglish (US)
Pages (from-to)591-599
Number of pages9
JournalJACC: Heart Failure
Volume4
Issue number7
DOIs
StatePublished - Jul 1 2016

Keywords

  • Acute heart failure
  • Emergency department
  • Risk stratification
  • Serelaxin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Pang, P. S., Teerlink, J. R., Voors, A. A., Ponikowski, P., Greenberg, B. H., Filippatos, G., Felker, G. M., Davison, B. A., Cotter, G., Kriger, J., Prescott, M. F., Hua, T. A., Severin, T., & Metra, M. (2016). Use of High-Sensitivity Troponin T to Identify Patients With Acute Heart Failure at Lower Risk for Adverse Outcomes. An Exploratory Analysis From the RELAX-AHF Trial. JACC: Heart Failure, 4(7), 591-599. https://doi.org/10.1016/j.jchf.2016.02.009