Poster 1035: Prognostic Implications of High-Sensitivity Cardiac Troponin T and I Elevations in Hypertensive Emergency: Results from the CONTRAST Trial

Background: Many patients presenting with hypertensive urgency have increased high-sensitivity cardiac troponin (hs-cTn) concentrations, which is often attributed to elevated blood pressure. Our study goal was to determine the prognostic implications of increased hs-cTn in hypertensive patients presenting to an emergency department (ED).

Methods: Consecutive ED patients undergoing serial hs-cTn testing on clinical indication were studied in the “COmparisoN of High-sensitivity Cardiac TRoponin I and T ASsays (CONTRAST) Trial (NCT 03214029). hs-cTn I and hs-cTnT testing was performed using the Abbott Architect and Roche Cobas assays, respectively. Baseline hs-cTn was run continuously in a logistic regression model examining the interaction between hs-cTn and degree of hypertension. The primary outcome was acute myocardial infarction (MI) at presentation.

Outcome: 2190 patients were included from November 2017 to March 2018. 58% were male, 42% female, 46% white, and 46% black. Systolic blood pressure (SBP) was < 140 mmHg in 1246 patients (56.9%), 140-180 mmHg in 787 (35.9%), and > 180 mmHg in 157 (7.2%). The incidence of myocardial injury and MI increased with higher SBP (For injury: < 140 mmHg: 20.3%, 140-180 mmHg: 19.8%, >180 mmHg: 31.2%; For MI: < 140 mmHg: 7.4%, 140-180 mmHg: 5.7%, >180 mmHg: 10.8%). Every 1 ng/L increase in hs-cTnI was associated with an increased odds of MI in patients with SBP < 140 mmHg (OR: 1.003, 95% CI: 1.002-1.005), 140-180 mmHg (OR: 1.005, 95% CI 1.003-1.008), and >180 mmHg (OR: 1.005, 95% CI 1.001-1.009) compared to patients with normal systolic blood pressure. Every 1 ng/L increase in hs-cTnT was associated with an increased odds of MI in patients with BP < 140 mmHg (OR: 1.007, 95% CI: 1.005-1.01), 140-180 mmHg (OR: 1.001, 95% CI 1.0-1.001), and >180 mmHg (OR: 1.006, 95% CI 1.0-1.012).

Conclusion: Among a diverse contemporary cohort of hypertensive patients, increases in hs-cTn I and T were prognostically important, and the prognostic implications changed as a function of blood pressure. hs-cTnT was more likely to be increased with higher blood pressures and associated with an increased risk of acute myocardial infarction.