Prognostic value of delta high-sensitivity cardiac troponin T in non-ST elevation acute coronary syndrome patients

¹Department of Emergency Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
²Biostatics Collaboration Unit, Department of Biomedical System Informatics, Yonsei University College of Medicine, Seoul, Korea
³Department of Emergency Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea

Correspondence

Tae Sik Hwang ,Tel: 031-5189-8985, Fax: 031-5189-8979, Email: emhwang1@hanmail.net,

Received: September 5, 2024; Revised: November 5, 2024 Accepted: December 5, 2024. Published online: October 30, 2025.

ABSTRACT

Objective:
According to the European Society of Cardiology guidelines, the timing of coronary angiography (CAG) and reperfusion treatment in non-ST elevation acute coronary syndrome (NSTE-ACS) is determined based on risk stratification. High-sensitivity cardiac troponin (hs-cTn) is a risk assessment factor that reflects the ischemic time and myocardial damage in ACS patients, and has the limitation of being reflected only dichotomously in evaluation tools. This study compared the mortality rates based on the delta(Δ) hs-TnT values to evaluate their association with prognosis.
Methods:
This study included NSTE-ACS patients who underwent CAG after visiting a local emergency center with chest pain, dyspnea, and palpitation from January to December 2021. The patients were grouped based on whether their Δhs-TnT was ≥457 pg/mL, and the 24-month mortality rates were compared as the primary outcome.
Results:
Of the 838 patients, 358 were included in the study. One hundred and nine patients had a Δhs-TnT (the difference between the first and maximum values) greater than or equal to 457 pg/mL, and 249 patients had a Δhs-TnT less than the cut-off value. A comparison of the mortality rates within 24 months between the two groups revealed a hazard ratio (HR) for patients with Δhs-TnT ≥457 pg/mL of 2.035, showing a significant difference (95% confidence interval [CI], 1.161-3.567; P=0.013). Subgroup analysis of these patients revealed a significant difference between early and delayed invasive strategies (HR in the delayed intervention group, 7.848; 95% CI, 3.325-18.519, P<0.001).
Conclusion:
In NSTE-ACS patients, mortality increased when Δhs-TnT was 457 pg/mL or greater. In patients with Δhs-TnT ≥457 pg/mL, mortality decreased when reperfusion therapy was performed within 24 hours.

Key words: Acute coronary syndrome; Troponin; Biomarkers