404 Association of Troponin Delta With 30-Day Major Adverse Cardiovascular Events

Document Type

Conference Proceeding

Publication Date

9-1-2025

Publication Title

Ann Emerg Med

Abstract

Study Objectives: Evaluating chest pain and suspected acute coronary syndrome (ACS) heavily relies on high-sensitivity cardiac troponin assays. Analysis of dynamic troponin changes (troponin delta) is essential in this evaluation, yet the prognostic value of delta increases vs decreases are not well defined. This study examines how troponin delta categories (increase, decrease, and stable) correlate with 30-day all-cause mortality/myocardial infarction (MI) and coronary revascularization. Methods: The retrospective cohort study assessed adult patients who presented with chest pain to 10 Michigan emergency departments (ED) during 2020–2022. Patients eligible for the study received at least two high-sensitivity cardiac troponin (hs-cTnI) measurements taken in the emergency department (ED) (0, 1, and/or 3 hour), with all EDs using the same assay (Beckman Coulter hs-cTnI). We excluded those age <18 years and patients with ST-elevation MI. Troponin delta was defined as the percentage change between serial values: >20% increase, >20% decrease, or ≤20% change (stable). The primary outcome was a composite of 30-day mortality/MI, and the secondary outcome was revascularization. Logistic regression models adjusted for demographics, comorbidities, and clinical variables. We present adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results: There were 21,912 patients included in the cohort with a mean age of 56 years and 52.7% female. The median and interquartile ranges in each troponin category are as follows: decrease (14.0 [8.0, 35.0] ng/L), increase (23.0 [6.0, 133.0] ng/L), and stable (4.0 [4.0, 6.0] ng/L). The primary outcome occurred in 33.2% of patients with a delta increase, 16.5% with a delta decrease, and 6.0% with a stable delta. A troponin delta increase was strongly associated with the primary outcome (aOR = 4.98; 95% CI: 4.35–5.71, p <0.001). A troponin delta decrease was modestly associated with the primary outcome (aOR = 2.61; 95% CI: 1.87–2.65, p < 0.001). Rates of revascularization were not statistically significant across delta categories. Conclusion: Troponin delta serves as an independent predictor for 30-day mortality/MI among patients experiencing chest pain in ED settings. While it had a more modest association, delta decrease was an independent predictor. No, authors do not have interests to disclose

Volume

86

Issue

3

First Page

S176

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