The prognosis in patients with chest pain and chronic myocardial injury compared with
patients with non-ST-segment elevation myocardial infarction (NSTEMI) is unknown.
This study aims to investigate differences in long-term outcomes. Patients with chest
pain at Karolinska University Hospital, Sweden from 2011 to 2014, who had stable high-sensitivity
cardiac troponin T (hs-cTnT) levels were compared with patients with NSTEMI. We estimated
hazard ratios with 95% confidence intervals for the risk of all-cause mortality, myocardial
infarction, and heart failure at different hs-cTnT levels using patients with NSTEMI
as referent. A total of 20,387 patients were included, of whom 927 had NSTEMI. Among
19,460 patients with stable hs-cTnT levels, 1,528 had chronic myocardial injury defined
as stable hs-cTnT levels > 14 ng/L. Mean follow-up was 3.2 years. Patients with hs-cTnT
levels of <5 and 5 to 9 ng/L had a lower risk, while patients with chronic myocardial
injury with hs-cTnT levels of 30 to 49 and ≥50 ng/L had a higher risk of death (adjusted
hazard ratios, 95% confidence intervals: 1.65, 1.30 to 2.10 and 2.13, 1.60 to 2.84,
respectively) compared with patients with NSTEMI. Patients with hs-cTnT levels <15
ng/L had a lower risk of heart failure, with no difference in risk at higher hs-cTnT
levels. All stable hs-cTnT levels were associated with a lower risk of myocardial
infarction (MI). In conclusion, patients with chest pain and stable hs-cTnT levels
10 to 29 ng/L have a similar risk, and those with chronic myocardial injury with hs-cTnT
levels of ≥30 ng/L have an increased risk of long-term all-cause mortality compared
with patients with NSTEMI.
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Article info
Publication history
Published online: September 14, 2018
Accepted:
September 5,
2018
Received in revised form:
August 19,
2018
Received:
July 4,
2018
Footnotes
Funding: Dr Holzmann has received consultancy honoraria from Actelion, Idorsia, and Pfizer. Dr Ljung has received consultancy honoraria from Pfizer. Dr Ljung is employed at the Swedish Medical Products Agency, SE-751 03 Uppsala, Sweden. The views expressed in this report do not necessarily represent the views of the Government agency. The remaining authors declare no conflicts of interest.
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© 2018 Elsevier Inc. All rights reserved.
