Elevated high-sensitivity troponin I independently predicted a significantly higher risk of major adverse cardiovascular events in stable patients with type 2 diabetes mellitus (adjusted HR 2.85).
Cohort (n=276)
No
Does elevated hs-TnI predict MACE in stable patients with T2DM?
Elevated hs-TnI is an independent predictor of future MACE in stable T2DM patients, while a normal level provides excellent negative predictive value, suggesting its utility for risk stratification.
Hazard Ratio: 2.85 (95% CI 1.15–7.03)
Absolute Event Rate: 9.3% vs 1.6%
p-value: p=0.02
INTRODUCTION: High-sensitivity cardiac troponin I(hs-TnI) and T levels(hs-TnT) are sensitive biomarkers of cardiomyocyte turnover or necrosis. Prior studies of the predictive role of hs-TnT in type 2 diabetes mellitus(T2DM) patients have yielded conflicting results. This study aimed to determine whether hs-TnI, which is detectable in a higher proportion of normal subjects than hsTnT, is associated with a major adverse cardiovascular event(MACE) in T2DM patients. METHODS AND RESULTS: We compared hs-TnI level in stored serum samples from 276 consecutive patients (mean age 65 ± 10 years; 57% male) with T2DM with that of 115 age-and sex-matched controls. All T2DM patients were prospectively followed up for at least 4 years for incidence of MACE including heart failure(HF), myocardial infarction(MI) and cardiovascular mortality. At baseline, 274(99%) patients with T2DM had detectable hs-TnI, and 57(21%) had elevated hs-TnI (male: 8.5 ng/L, female: 7.6 ng/L, above the 99th percentile in healthy controls). A total of 43 MACE occurred: HF(n = 18), MI(n = 11) and cardiovascular mortality(n = 14). Kaplan-Meier analysis showed that an elevated hs-TnI was associated with MACE, HF, MI and cardiovascular mortality. Although multivariate analysis revealed that an elevated hs-TnI independently predicted MACE, it had limited sensitivity(62.7%) and positive predictive value(38.5%). Contrary to this, a normal hs-TnI level had an excellent negative predictive value(92.2%) for future MACE in patients with T2DM. CONCLUSION: The present study demonstrates that elevated hs-TnI in patients with T2DM is associated with increased MACE, HF, MI and cardiovascular mortality. Importantly, a normal hs-TnI level has an excellent negative predictive value for future adverse cardiovascular events during long-term follow-up.
Yiu et al. (Tue,) conducted a cohort in Type 2 diabetes mellitus (n=276). Elevated high-sensitivity troponin I (hs-TnI) vs. Normal hs-TnI level was evaluated on Major adverse cardiovascular event (MACE), a composite of heart failure requiring hospital admission, myocardial infarction, and cardiovascular mortality (HR 2.85, 95% CI 1.15-7.03, p=0.02). Elevated high-sensitivity troponin I independently predicted a significantly higher risk of major adverse cardiovascular events in stable patients with type 2 diabetes mellitus (adjusted HR 2.85).