Key result
Higher concentrations of hs-cTnT were more strongly associated with long-term all-cause mortality than hs-cTnI in patients with chest pain (HR 2.40; 95% CI 1.75-3.30; p<0.001).
Why the study?
The individual troponin isotype association of cTnT and cTnI with long-term mortality in patients with suspected unstable angina pectoris was less clear.
Does high sensitivity cardiac troponin T provide better long-term prognostic value than high sensitivity cardiac troponin I for all-cause mortality in patients hospitalized with chest pain?
Cohort
Does high sensitivity cardiac troponin T provide better long-term prognostic value than high sensitivity cardiac troponin I for all-cause mortality in patients hospitalized with chest pain?
Hazard Ratio: 2.4 (95% CI 1.75–3.3)
p-value: p=< 0.001
In patients hospitalized with chest pain, hs-cTnT provides superior long-term prognostic value for all-cause mortality compared to hs-cTnI.
hs-cTnT may aid long-term risk stratification in suspected UAP; extends comparative prognostic data but leaves open prospective validation.
BACKGROUND: Cardiac troponins (cTn) are essential in the diagnostic assessment of non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). Elevated concentrations of cTnT and cTnI predict cardiovascular events in non-acute settings, but the individual troponin isotype association with long-term mortality in patients with suspected unstable angina pectoris (UAP) is less clear. METHODS: Patients hospitalized with chest pain between June 2009 and December 2010 were included in the Akershus Cardiac Examination 3 Study and followed for median 6.6 (IQR 6.2-7.1) years. The index diagnosis was adjudicated by an independent committee as NSTE-myocardial infarction (NSTEMI), UAP or non-ACS. Blood samples were collected within 24 h of admission and analyzed with high sensitivity assays for cTnT (hs-cTnT, Roche) and cTnI (hs-cTnI, Singulex). RESULTS: -transformed hs-cTnT and hs-cTnI were associated with all-cause mortality in analyses that adjusted for other risk factors: HR 2.40 [95% CI 1.75-3.30], p < 0.001 and HR 1.44 [1.14-1.81], p = 0.002. There were no significant sex-dependent differences in the association between hs-cTnT or hs-cTnI and outcome. Time dependent receiver-operating characteristics area under the curve was 0.85 (95% CI 0.79-0.92) for hs-cTnT and 0.74 (0.64-0.84) for hs-cTnI, p = 0.008 for difference between values. CONCLUSIONS: Higher concentrations of hs-cTnT and hs-cTnI were both associated with all-cause mortality in patients with UAP, but the association with outcome was stronger for hs-cTnT than for hs-cTnI.
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Tveit et al. (2019) conducted a cohort in Chest pain / suspected unstable angina pectoris. High sensitivity cardiac troponin T (hs-cTnT) vs. High sensitivity cardiac troponin I (hs-cTnI) was evaluated on All-cause mortality (HR 2.40, 95% CI 1.75-3.30, p=< 0.001). Higher concentrations of hs-cTnT were more strongly associated with long-term all-cause mortality than hs-cTnI in patients with chest pain (HR 2.40; 95% CI 1.75-3.30; p<0.001).