[Prognostic value of troponin in patients with acute heart failure attended in Spanish Emergency Departments: TROPICA study (TROPonin in acute heart failure)]

Background and objective: To determine whether positive or negative troponin values determined in the Emergency Department (ED) in patients with acute heart failure (AHF) can predict short-term evolution (30-day intrahospitalary mortality and reconsultation at 30 days).

Patients and methods: A retrospective, analytical, multicenter study with a follow-up of cohorts including patients diagnosed with AHF using the Framingham clinical criteria. Patients with acute coronary syndrome concomitant with AHF were excluded. Data were collected at baseline and during the acute episode in each case. Troponin was considered as a dependent variable and variables of outcome results included intrahospitalary mortality and mortality and reconsultation to the ED within the following 30 days. Hazard ratios (HR) adjusted for differences in the basal state and during the acute episode, were calculated with their 95% confidence intervals (CI 95%) for troponin positive patients.

Results: We included 806 patients from 17 Spanish EDs, 250 of whom (31%) were troponin-positive. The global intrahospitalary mortality was 9.2%, being 10.4% at 30 days and 21.3% reconsulted to the ED within 30 days. The troponin positive patients had a greater intrahospitalary (HR: 3.85; CI 95%: 2.33-6.34) 30-day mortality (HR: 3.07; CI 95%: 1.98-4.78) but not a greater reconsultation to the ED within 30 days (HR: 0.88; CI 95%: 0.62-1.26). All these findings were maintained after adjustment for the presence of chronic renal insufficiency, functional dependence, reduced glomerular filtration, treatment with nitroglycerin, with angiotensin enzyme inhibitors or angiotensin ii receptor antagonists in the ED and on hospital admission.

Conclusion: Troponin positivity in the ED in patients with AHF is independently associated with a greater intrahospitalary and 30-day mortality but not with a greater rate of reconsultation to the ED during the following 30 days. The availability of troponin analysis in all EDs makes its determination recommended in all patients with AHF to allow evaluation of early short-term prognosis.