Three-year changes in high-sensitivity cardiac troponin-T and total mortality in older adults.

Elevated high-sensitivity cardiac troponin-T (hs-cTnT) is associated with mortality in older adults. However, little is known about the implications of changes over time. We investigated hs-cTnT 3-year change and its association with subsequent mortality in the Activity and Function in the Elderly Study. Participants with baseline and follow-up hs-cTnT < 5 ng/L built the reference group (G1 = 156). Five groups were defined among those with an increment over time: Undetectable at baseline: follow-up < 14 ng/L (G2 = 295), follow-up ≥ 14 ng/L (G3 = 24). Baseline 5 to <14 ng/L: follow-up < 14 ng/L (G4 = 101), follow-up ≥ 14 ng/L (G5 = 96). G6 included baseline and follow-up > 14 ng/L (n = 74). Cox-proportional hazards models evaluated the association with mortality adjusting for age, sex, education, cardiovascular disease, chronic kidney disease, number of medications, hs-CRP, and NT-proBNP. Among 745 participants (median age 75.9 years, 58.9% male) we observed 98 deaths (median follow-up 4.8 years). G1 had the lowest mortality rate (MR) (5.2 per 1000 person-years). The highest MR were observed by follow-up ≥ 14 ng/L: G3: 95.4 and G6: 100.4 per 1000 person-years, with an adjusted hazard ratio of 5.22 [95% CI 1.46, 18.65] and 3.40 [95% CI 1.02, 11.34], respectively. Hs-cTnT trajectories could help to identify older adults with a high mortality risk even after further adjustment including hs-CRP and NT-proBNP.