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

*Corresponding author for this work

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Abstract

OBJECTIVES The aim of this study was to determine if a baseline high-sensitivity troponin T (hsTnT) value

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

Original languageEnglish
Pages (from-to)591-599
Number of pages9
JournalJACC. Heart failure
Volume4
Issue number7
DOIs
Publication statusPublished - Jul-2016

Keywords

  • acute heart failure
  • emergency department
  • risk stratification
  • serelaxin
  • EMERGENCY-DEPARTMENT
  • CARDIAC TROPONIN
  • MORTALITY
  • HOSPITALIZATION
  • STRATIFICATION
  • PREDICTION
  • DESIGN
  • VALIDATION
  • BIOMARKERS
  • ADMISSIONS

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