Impact of subthreshold troponin levels and temporal trends on short term adverse cardiovascular outcomes in patients discharged from the emergency department: a RACE-IT trial substudy.
Muhammad Ahmad Qureshi, Bernard Cook, Benjamin Brennan et al.
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In 30 seconds
This post-hoc analysis of the RACE-IT stepped-wedge randomized controlled trial examined whether subthreshold high-sensitivity troponin I levels and their changes were associated with 30-day outcomes among patients with troponin ≤18 ng/L across nine emergency departments. Of 19,194 patients, 117 (0.6%) experienced the composite of death, acute myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting. After adjustment, troponin levels and temporal changes were not independently associated with outcomes overall, although peak values of ≥11–≤18 ng/L remained associated with worse outcomes than lower peaks.
Key findings
- Among 19,194 patients with troponin ≤18 ng/L, 117 (0.6%) had the 30-day composite outcome.
- Adjusted analyses found no independent association between troponin levels or temporal changes and outcomes overall.
- Peak troponin values of ≥11–≤18 ng/L remained associated with worse outcomes than lower peak levels.
Why it matters
The findings suggest that detectable troponin below the 99th percentile upper reference limit does not, by itself, independently predict short-term adverse outcomes across this population. They also indicate that higher subthreshold peaks may identify patients with greater risk, while age, comorbidity, and other clinical context remain relevant to assessment.
What to keep in mind
This was a post-hoc analysis, and the reported adjusted findings do not establish that subthreshold troponin levels or changes cause outcomes.