General

Clinical Question:
Does elevation in cardiac troponin levels predict the outcome of patients with acute heart failure?

Bottom Line:
An elevated cardiac troponin I or T level is associated with longer length of stay and higher in-hospital mortality for patients with acutely decompensated heart failure. (LOE = 2b)

Reference:
Peacock WF 4th, De Marco T, Fonarow GC, et al, for the ADHERE Investigators. Cardiac troponin and outcome in acute heart failure. N Engl J Med 2008:358:2117-2126.  [PMID:18480204]

Study Design:
Cohort (prospective)

Setting:
Inpatient (any location)

Synopsis:
The authors used the Acute Decompensated Heart Failure National Registry (ADHERE) database to explore the ability of cardiac troponin to predict adverse outcomes in patients admitted to the hospital with heart failure. The authors identified 67,924 adults admitted with acute decompensated heart failure who had a cardiac troponin I or T level measured within 24 hours of admission. Patients were followed up prospectively and outcome data were entered in the registry. Patients with serum creatinine levels greater than 2.0 mg/dL were excluded, and results for troponin I and T were pooled. Cutoffs of 0.1 mcg/L for troponin T and 1.0 mcg/L for troponin I were used. The mean age of patients was 73 years, 47% were men, and 20% were black. Overall, 6.2% of patients had a positive initial troponin. The unadjusted in-patient mortality was higher for patients with an abnormal initial troponin (8.0% vs 2.7%; P < .001); the adjusted odds ratio was 2.55 (95% CI, 2.24 - 2.89). The mortality difference increased with an increasing duration of hospitalization and with increasing levels of troponin. For example, in-hospital mortality was 2.0% for troponin I levels less than or equal to 0.04 mcg/L, 2.7% for levels of 0.04 to 0.10 mcg/L, 3.4% for 0.11 to 0.20 mcg/L, and 5.3% for greater than 0.20 mcg/L. A similar trend was seen for troponin T levels. Patients with a positive troponin level had longer stays in the hospital, including longer intensive care unit stays, and were more likely to require invasive procedures.