Key result
High-sensitivity cardiac troponin T alone was superior to the ESC-SCORE for predicting all-cause mortality in stable outpatients with cardiovascular disease (ΔAUC 0.221, p=0.0039).
Why the study?
Does a high-sensitivity cardiac troponin T (hs-cTnT) single biomarker strategy improve risk prediction compared to the ESC-SCORE for all-cause mortality in low-risk outpatients with stable cardiovascular disease?
Cohort (n=2,739)
Yes
Does a high-sensitivity cardiac troponin T (hs-cTnT) single biomarker strategy improve risk prediction compared to the ESC-SCORE for all-cause mortality in low-risk outpatients with stable cardiovascular disease?
Effect estimate: ΔAUC 0.221
p-value: p=0.0039
A single hs-cTnT measurement provides superior prognostic value for all-cause mortality compared to the multivariable ESC-SCORE in stable low-risk outpatients.
hs-cTnT may aid mortality risk stratification in stable CVD outpatients; leaves open whether it should replace ESC-SCORE pending validation.
Objective: To evaluate the prognostic performance of high-sensitivity cardiac troponin T (hs-cTnT) compared with the ESC-SCORE. Methods: We included low-risk outpatients with stable cardiovascular (CV) disease categorised into need for non-secondary and secondary prevention. The prognostication of hs-cTnT at index visit was compared with the European Society of Cardiology-Systematic COronary Risk Evaluation (ESC-SCORE) with respect to all-cause mortality (ACM) and two composite endpoints (ACM, acute myocardial infarction (AMI) and stroke and ACM, AMI, stroke and rehospitalisation for acute coronary syndrome (ACS) and decompensated heart failure (DHF)). Results: Within a median follow-up of 796 days, a total of 16 deaths, 32 composite endpoints of ACM, AMI and stroke and 83 composite endpoints of ACM, AMI, stroke, rehospitalisation for ACS and DHF were observed among 693 stable low-risk outpatients. Using C-statistics, measurement of hs-cTnT alone outperformed the ESC-SCORE for the prediction of ACM in the entire study population (Δarea under the curve (AUC) 0.221, p=0.0039) and both prevention groups (non-secondary: ΔAUC 0.164, p=0.0208; secondary: ΔAUC 0.264, p=0.0134). For the prediction of all other secondary endpoints, hs-cTnT was at least as effective as the ESC-SCORE, both in secondary and non-secondary prevention. Using continuous and categorical net reclassification improvement and integrated discrimination improvement, hs-cTnT significantly improved reclassification regarding all endpoints in the entire population and in the secondary prevention cohort. In non-secondary prevention, hs-cTnT improved reclassification only for ACM. The results were confirmed in an independent external cohort on 2046 patients. Conclusions: Hs-cTnT is superior to the multivariable ESC-SCORE for the prediction of ACM and a composite endpoint in stable outpatients with and without relevant CV disease. Trial registration number: NCT01954303; Pre-results.
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Biener et al. (2018) conducted a cohort in stable cardiovascular disease (n=2,739). high-sensitivity cardiac troponin T (hs-cTnT) vs. ESC-SCORE was evaluated on all-cause mortality (ACM) (ΔAUC 0.221, p=0.0039). High-sensitivity cardiac troponin T alone was superior to the ESC-SCORE for predicting all-cause mortality in stable outpatients with cardiovascular disease (ΔAUC 0.221, p=0.0039).
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