High-sensitivity cardiac troponin I levels in the highest quartile were associated with increased risk of cardiovascular death or heart failure in stable CAD (HR 1.84; 95% CI 1.30-2.61; p<0.001).
Cohort (n=3,623)
Does elevated high-sensitivity cardiac troponin I predict cardiovascular death or heart failure in patients with stable coronary artery disease?
In patients with stable CAD, elevated hs-TnI concentrations independently predict cardiovascular death or heart failure, providing prognostic value beyond conventional risk markers and hs-TnT.
Effect estimate: HR 1.84 (95% CI 1.30-2.61)
p-value: p=<0.001
OBJECTIVES: The aims of this study were to assess the prognostic value of cardiac troponin I levels, measured with a new high-sensitivity assay, in low-risk patients with stable coronary artery disease (CAD) and to contrast its determinants and prognostic merit with that of high-sensitivity cardiac troponin T (hs-TnT). BACKGROUND: New, highly sensitive cardiac troponin assays permit evaluation of the association between troponin levels and outcomes in patients with stable CAD. METHODS: High-sensitivity cardiac troponin I (hs-TnI) levels at baseline were assessed in 3,623 patients with stable CAD and preserved systolic function enrolled in the PEACE (Prevention of Events With Angiotensin-Converting Enzyme Inhibitor Therapy) trial. RESULTS: In total, 98.5% of patients had hs-TnI concentrations higher than the detection level (1.2 pg/ml). hs-TnI correlated moderately with hs-TnT (r = 0.44) and N-terminal pro-B-type natriuretic peptide (r = 0.39) but only weakly with age (r = 0.17) and estimated glomerular filtration rate (r = -0.11). During a median follow-up period of 5.2 years, 203 patients died of cardiovascular causes or were hospitalized for heart failure, and 209 patients had nonfatal myocardial infarctions. In analyses adjusting for conventional risk markers, N-terminal pro-B-type natriuretic peptide, and hs-TnT, hs-TnI levels in the fourth compared with the 3 lower quartiles were associated with the incidence of cardiovascular death or heart failure (hazard ratio: 1.84; 95% confidence interval: 1.30 to 2.61; p < 0.001). corrected. There was a corrected weaker association with nonfatal myocardial infarction (hazard ratio: 1.37; 95% confidence interval: 0.98 to 1.92; p = 0.066). corrected. In the same models, hs-TnT concentrations were associated with the incidence of cardiovascular death or heart failure but not of myocardial infarction. CONCLUSIONS: In patients with stable CAD, hs-TnI concentrations are associated with cardiovascular risk independently of conventional risk markers and hs-TnT. (Prevention of Events With Angiotensin-Converting Enzyme Inhibitor Therapy PEACE; NCT00000558).
“High-sensitivity troponin is really going to be a major learning experience. First, we have the issue where in the ER they can make a diagnosis of ACS faster, but what's happened in the past is you have cardiologists say, 'Well, this person's troponin didn't go up and down so it's not an MI.' They'd say it's a false-positive. Well, guess what? It's not a false positive. People with chronic elevations in troponin have an increased risk for cardiovascular events.”
Omland et al. (Thu,) conducted a cohort in stable coronary artery disease (CAD) (n=3,623). High-sensitivity cardiac troponin I (hs-TnI) highest quartile vs. 3 lower quartiles was evaluated on incidence of cardiovascular death or heart failure (HR 1.84, 95% CI 1.30-2.61, p=<0.001). High-sensitivity cardiac troponin I levels in the highest quartile were associated with increased risk of cardiovascular death or heart failure in stable CAD (HR 1.84; 95% CI 1.30-2.61; p<0.001).