Evaluating prognostic performance for acute delta changes of high-sensitivity cardiac troponin T in emergency department patients

OBJECTIVES To evaluate the prognostic value of 0/1h and 0/3h high-sensitivity cardiac troponin T (hs-cTnT) delta values for 30-day and 1-year all-cause mortality among emergency department (ED) patients. METHODS This retrospective study included two study cohorts from two academic medical centers. Cohort 1 included 18,022 ED patients with hs-cTnT measured using 0/3h algorithm, and Cohort 2 included 5,003 ED patients with hs-cTnT tested using 0/1h algorithm. hs-cTnT deltas were stratified into four categories: <4, 4-7, 8-11, and ≥ 12 ng/L for 0/3h testing, and < 3, 3-5, 6-8, and ≥ 9 ng/L for 0/1h testing. Kaplan-Meier analysis, multivariable Cox proportional hazard models, and multivariable logistic regression models were performed to assess the prognostic values of 1 h and 3 h delta hs-cTnT for mortality. RESULTS 0/1h and 0/3h hs-cTnT deltas were significantly higher in patients who died within 30 days or 1 year compared with survivors. After adjustment for baseline hs-cTnT, age, sex, and eGFR, a 3 h delta ≥ 4 ng/L was associated with approximately 2-fold higher 30-day mortality and 1.6-fold higher 1-year mortality; ≥12 ng/L was associated with approximately 4-fold and 2-fold increases in mortality risk, respectively. The 1 h delta showed similar predictive performance. In continuous log2-transformed models, each doubling of delta hs-cTnT increased the 30-day and 1-year mortality by 22% and 11% in the 0/3h algorithm and by 14% and 10% in the 0/1h algorithm. Incorporating delta hs-cTnT into multivariable logistic models improves model performance, with higher AUCs and lower AICs than models with baseline hs-cTnT alone. CONCLUSIONS Acute hs-cTnT delta changes provide strong and independent prognostic information for all-cause mortality in ED patients. Incorporating delta hs-cTnT into ED risk stratification may support early identification of high-risk patients.