Do High Sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?

Abstract

Objective

An estimated 1.2 million annual emergency department (ED) visits for syncope/ near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high‐sensitivity troponin (hscTnT) and Natriuretic Peptide (NT‐proBNP) are unclear. The objective of this study was to determine if hscTnT and NT‐proBNP drawn in the ED are independently associated with 30‐day death/ serious cardiac outcomes in adult patients presenting with syncope.

Methods

A pre‐specified secondary analysis of a prospective, observational trial enrolling participants ≥ age 60 presenting with syncope, at 11 United States hospitals, was conducted between 4/2013 and 9/2016. Exclusions included seizure, stroke, transient ischemic attack, trauma, intoxication, hypoglycemia, persistent confusion, mechanical/electrical invention, prior enrollment, or predicted poor follow‐up. Within 3 hours of consent, hscTnT and NT‐proBNP were collected and later analyzed centrally using Roche Elecsys Gen 5 STAT^® and 2010 Cobas^® respectively. Primary outcome was combined 30‐day all‐cause mortality and serious cardiac events. Adjusting for illness severity, using multivariate logistical regression analysis, variations between primary outcome and biomarkers were estimated, adjusting absolute risk associated with ranges of biomarkers using Bayesian Markov Chain Monte Carlo methods.

Results

The cohort included 3,392 patients; 367 (10.8%) experienced the primary outcome. Adjusted absolute risk for the primary outcome increased with hscTnT and NT‐proBNP levels. HscTnT levels ≤ 5 ng/L were associated with a 4% (95%CI: 3‐5%) outcome risk; hscTnT >50 ng/L, a 29% (95%CI: 26‐33%) risk. NT‐proBNP levels ≤ 125 ng/L were associated with a 4% (95%CI: 4‐5%) risk; NT‐proBNP > 2000 ng/L a 29% (95%CI: 25‐32%) risk. Likelihood ratios and predictive values demonstrated similar results. Sensitivity analyses excluding ED index serious outcomes demonstrated similar findings.

Conclusion

HscTnT and NT‐proBNP are independent predictors of 30‐day death and serious outcomes in older ED patients presenting with syncope.

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