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Introduction:Long-term prognostic implications of serial high-sensitivity troponin concentrations in subjects with suspected acute coronary syndrome (ACS) are unknown.Hypothesis:To determine mortality according to high-sensitivity troponin I (TnI) concentrations and their changes from baseline, in patients with suspected ACS.Methods:Using Danish registries, we identified individuals with a first diagnosis of myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019 who underwent two high-sensitivity TnI (Siemens TnI Flex® Reagent, 99thpercentile 45 ng/l) measurements during the same hospitalization. Prognostic implications of serial sampling were examined stratifying subjects for normal and elevated concentrations, and for relative changes of 20% and 50%. Absolute and relative risks for death from any cause at days 0-30 and 31-365 were calculated through multivariable logistic regression with average treatment effect modeling.Results:Of the 20,609 individuals included, 2.3% had died at 30 days, while 4.7% of 30-day-survivors died between days 31-365. The standardized risk of death at both 0-30 and 31-365 days was highest among subjects with two elevated TnI concentrations (0-30 days: 8.0%, 31-365 days: 11.1%) and lowest among those with two normal TnI concentrations (0-30 days: 0.5%, 31-365 days: 2.6%). In neither case did relative changes between measurements clearly affect mortality. Nevertheless, among persons who went from a normal to an elevated TnI concentration, 30-day mortality was highest in those with a >50% rise versus subjects with a less pronounced rise (2.2% vs. <0.1%). The Figure shows the standardized absolute risk of death from any cause from days 31-365.Conclusions:Among individuals with suspected ACS, those with two elevated TnI concentrations consistently had the highest risk of death. Mortality was very low in subjects with two normal TnI values.

Evaluation of myocardial deformation by two-dimensional speckle-tracking is useful for clinical and research purposes. However, differences may exist among different ultrasound machines, software packages, frame rates, and observers.

Introduction:Emerging data show that complete revascularization reduces cardiovascular death and recurrent myocardial infarction in ST-segment elevation myocardial infarction (STEMI). The influence of revascularization status on development of arrhythmia in the chronic post-STEMI phase is poorly described.Hypothesis:We hypothesized that incomplete compared with complete revascularization in STEMI is associated with an increased long-term risk of new-onset arrhythmia.Methods:Using unique Danish registries, the risk of new-onset arrhythmia was assessed in STEMI with complete or incomplete revascularization after primary percutaneous coronary intervention (PPCI) at Rigshospitalet University Hospital, Denmark, from 2009-2016. The primary outcome was new-onset arrhythmia defined as a composite of atrial fibrillation/flutter, sinoatrial dysfunction, advanced 2nd- or 3rd-degree atrioventricular block, ventricular tachycardia/fibrillation, cardiac arrest, or pacemaker/ICD implantation, with presentation >7 days post-PPCI. Secondary outcome was all-cause mortality.Results:A total of 5,062 patients (median age: 62.0 years; 76% men) were included, of which 3,985 and 1,077 patients underwent complete and incomplete revascularization, respectively. During a median follow-up of 4.9 years, 580 (15%) patients in the complete and 217 (20%) patients in the incomplete revascularization group were diagnosed with new-onset arrhythmia (Figure 1). Compared with complete revascularization, incomplete revascularization was associated with a higher risk of new-onset arrhythmia (adjusted hazard ratio [HR] 1.3; 95% CI, 1.1-1.5; P=0.004) and higher all-cause mortality (adjusted HR 1.3; 95% CI, 1.0-1.5; P=0.02).Conclusions:Incomplete revascularization in STEMI was associated with an increased long-term risk of new-onset arrhythmia and all-cause mortality compared with complete revascularization.