Evidence map›Paper›PMID 29044915›Full record

Trial reportEuropean journal of heart failure2018

Pre-discharge and early post-discharge troponin elevation among patients hospitalized for heart failure with reduced ejection fraction: findings from the ASTRONAUT trial.

Stephen J Greene, Javed Butler, Gregg C Fonarow, Haris P Subacius, Andrew P Ambrosy, Muthiah Vaduganathan, Marco Triggiani, Scott D Solomon, Eldrin F Lewis, Aldo P Maggioni and 7 more

Registry-linked trialOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European journal of heart failure, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00894387 (A Multicenter, Randomized, Double-blind, Parallel Group, Placebo-controlled Study to Evaluate the 6 Months Efficacy and Safety of Aliskiren Therapy on Top of Standard Therapy, on Morbidity and Mortality When Initiated Early After Hospitalization for Acute Decompensated Heart Failure), which is not on this map. Cited by 23 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 3 pooled it
3.2field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00894387 phase3completednot on this map

A Multicenter, Randomized, Double-blind, Parallel Group, Placebo-controlled Study to Evaluate the 6 Months Efficacy and Safety of Aliskiren Therapy on Top of Standard Therapy, on Morbidity and Mortality When Initiated Early After Hospitalization for Acute Decompensated Heart Failure

TypeinterventionalSponsorNovartis PharmaceuticalsRan2009 to 2012Enrolled1,639ConditionsAcute Decompensated Heart Failure, Congestive Heart FailureArmsAliskiren, Placebo
3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 39 citations in OpenAlex.

  1. Pooled it
  2. Highlights in heart failure.ESC heart failure · 2019
    Pooled it
  3. Pooled it
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  17. Monitoring of biomarkers in heart failure.European heart journal supplements : journal of the European Society of Cardiology · 2019
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 13 institutions in 6 countries.

Stephen J GreeneDuke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
Javed ButlerDivision of Cardiology, Stony Brook University, Stony Brook, NY, USA.
Gregg C FonarowAhmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles, CA, USA.
Haris P SubaciusCenter for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Andrew P AmbrosyDuke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
Muthiah VaduganathanBrigham and Women's Hospital Heart and Vascular Center and Harvard Medical Center, Boston, MA, USA.
Marco TriggianiCardiology Section, Department of Clinical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Scott D SolomonBrigham and Women's Hospital Heart and Vascular Center and Harvard Medical Center, Boston, MA, USA.
Eldrin F LewisBrigham and Women's Hospital Heart and Vascular Center and Harvard Medical Center, Boston, MA, USA.
Aldo P MaggioniItalian Association of Hospital Cardiologists, ANMCO Research Center, Florence, Italy.
Michael BöhmKlinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Ovidiu ChioncelInstitute of Emergency for Cardiovascular Diseases Professor C. C. Iliescu, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
Savina NodariCardiology Section, Department of Clinical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Michele SenniDivision of Cardiology 1, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Faiez ZannadInserm, Clinical Investigation Center CIC 1433, Université de Lorraine and CHRU Nancy, France.
Mihai GheorghiadeCenter for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
ASTRONAUT Investigators and Coordinators
Brigham and Women's Hospital · USNorthwestern University · USAssociazione Nazionale Medici Cardiologi Ospedalieri · ITCarol Davila University of Medicine and Pharmacy · ROClinical Research Institute · USDuke Medical Center · USInserm · FROspedale Papa Giovanni XXIII · ITStony Brook University · USSurgical Specialties (Canada) · CAUniversitätsklinikum des Saarlandes · DEUniversity of Brescia · ITUniversity of California, Los Angeles · US

Funding

TRAINING PROGRAM IN CARDIOVASCULAR RESEARCHT32HL007604 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI MARK W FEINBERG · 1985 to 2026
$19.0M
Postdoctoral Training in Cardiovascular Clinical ResearchT32HL069749 · NHLBI · DUKE UNIVERSITY · PI MARK, DANIEL B · 2003 to 2023
$6.7M
NHLBI NIH HHS T32 HL007604NHLBI NIH HHS T32 HL069749
6 · The paper itself

Abstract

aimsTroponin levels are commonly elevated among patients hospitalized for heart failure (HF), but the prevalence and prognostic significance of early post-discharge troponin elevation are unclear. This study sought to describe the frequency and prognostic value of pre-discharge and post-discharge troponin elevation, including persistent troponin elevation from the inpatient to outpatient settings. METHODS AND

resultsThe ASTRONAUT trial (NCT00894387; http://www.clinicaltrials.gov) enrolled hospitalized HF patients with ejection fraction ≤40% and measured troponin I prior to discharge (i.e. study baseline) and at 1-month follow-up in a core laboratory (elevation defined as >0.04 ng/mL). This analysis included 1469 (91.0%) patients with pre-discharge troponin data. Overall, 41.5% and 29.9% of patients had elevated pre-discharge [median: 0.09 ng/mL; interquartile range (IQR): 0.06-0.19 ng/mL] and 1-month (median: 0.09 ng/mL; IQR: 0.06-0.15 ng/mL) troponin levels, respectively. Among patients with pre-discharge troponin elevation, 60.4% had persistent elevation at 1 month. After adjustment, pre-discharge troponin elevation was not associated with 12-month clinical outcomes. In contrast, 1-month troponin elevation was independently predictive of increased all-cause mortality [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.18-2.13] and cardiovascular mortality or HF hospitalization (HR 1.28, 95% CI 1.03-1.58) at 12 months. Associations between 1-month troponin elevation and outcomes were similar among patients with newly elevated (i.e. normal pre-discharge) and persistently elevated levels (interaction P ≥ 0.16). The prognostic value of 1-month troponin elevation for 12-month mortality was driven by a pronounced association among patients with coronary artery disease (interaction P = 0.009).

conclusionsIn this hospitalized HF population, troponin I elevation was common during index hospitalization and at 1-month follow-up. Elevated troponin I level at 1 month, but not pre-discharge, was independently predictive of increased clinical events at 12 months. Early post-discharge troponin I measurement may offer a practical means of risk stratification and should be investigated as a therapeutic target.

Indexed as

AgedBiomarkersCause of DeathEuropeFemaleFollow-Up StudiesHeart FailureHumansMaleMiddle AgedPatient DischargePrognosisProspective StudiesRisk FactorsStroke VolumeSurvival RateBiomarkersTroponinHeart failureHospitalizationOutcomesPost-dischargeTroponin

Identifiers

PMID29044915
PMCPMC6429915
OpenAlexW2765935265

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.