Cardiac Troponin T and NT-proBNP for Prediction of 30-Day Readmission or Death in Patients with Acute Dyspnea: Data from the Akershus Cardiac Examination 2 Study

Cardiology. 2023;148(6):506-516. doi: 10.1159/000533266. Epub 2023 Aug 5.

Abstract

Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) measurements are recommended in patients with acute dyspnea. We aimed to assess the prognostic merit of cTnT compared to NT-proBNP for 30-day readmission or death in patients hospitalized with acute dyspnea.

Methods: We measured cTnT and NT-proBNP within 24 h in 314 patients hospitalized with acute dyspnea and adjudicated the cause of the index admission. Time to first event of readmission or death ≤30 days after hospital discharge was recorded, and cTnT and NT-proBNP measurements were compared head-to-head.

Results: Patients who died (12/314) or were readmitted (71/314) within 30 days had higher cTnT concentrations (median: 32.6, Q1-Q3: 18.4-74.2 ng/L vs. median: 19.4, Q1-Q3: 8.4-36.1 ng/L; p for comparison <0.001) and NT-proBNP concentrations (median: 1,753.6, Q1-Q3: 464.2-6,862.0 ng/L vs. median 984, Q1-Q3 201-3,600 ng/L; for comparison p = 0.027) compared to patients who survived and were not readmitted. cTnT concentrations were associated with readmission or death within 30 days after discharge both in the total cohort (adjusted hazard ratio [aHR]: 1.64, 95% confidence interval [CI]: 1.30-2.05) and in patients with heart failure (HF) (aHR: 1.58, 95% CI: 1.14-2.18). In contrast, NT-proBNP concentrations were not associated with short-term events, neither in the total cohort (aHR: 1.10, 95% CI: 0.94-1.30) nor in patients with adjudicated HF (aHR: 1.06, 95% CI: 0.80-1.40).

Conclusion: cTnT concentrations are associated with 30-day readmission or death in patients hospitalized with acute dyspnea, as well as in patients adjudicated HF.

Keywords: Acute dyspnea; Cardiac troponin T; Heart Failure; N-terminal pro-B-type natriuretic peptide; Readmission.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Biomarkers / metabolism
  • Dyspnea* / blood
  • Dyspnea* / diagnosis
  • Dyspnea* / mortality
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain* / blood
  • Natriuretic Peptide, Brain* / metabolism
  • Patient Readmission* / statistics & numerical data
  • Predictive Value of Tests
  • Troponin T* / blood
  • Troponin T* / metabolism

Substances

  • TNNT2 protein, human
  • Troponin T
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Biomarkers

Grants and funding

This work was supported by a research grant from the Norwegian Research Council (197992/B-07029) to T.O. and H.R. and by internal grants from Akershus University Hospital (41810/340104). Roche Diagnostics supported the study by providing reagents at a reduced price to Akershus University Hospital.