Elevated baseline levels of high-sensitivity troponin I (HR 1.75) and B-type natriuretic peptide (HR 1.42) independently increased the risk of major adverse cardiovascular events in patients with stable coronary artery disease.
Cohort (n=2,275)
No
Does the addition of hs-TnI and BNP to conventional risk factors improve the prediction of MACE in patients with stable CAD with and without T2DM?
Elevated hs-TnI and BNP are independent predictors of MACE in stable CAD patients, providing incremental predictive value beyond conventional risk factors, particularly in those without diabetes.
Effect estimate: HR 1.75 (95% CI 1.41-2.17)
p-value: p=<0.001
BACKGROUND: High-sensitivity troponin I (hs-Tnl) and B-type natriuretic peptide (BNP) are promising prognostic markers for coronary artery disease (CAD). This prospective cohort study investigated whether a combination of these cardiac biomarkers with conventional risk factors would add incremental value for the prediction of secondary major adverse cardiovascular events (MACEs) in patients with CAD, with and without type 2 diabetes mellitus (T2DM). METHODS: Baseline plasma level of hs-Tnl and BNP was measured in 2275 Chinese patients with stable CAD. Patients were monitored for new-onset of MACE over a median of 51 months. Cox proportional hazard model and area under the receiver operating characteristic curve (AUC) were used to assess the association of cardiac biomarkers with MACE and their predictive values in relationship with or without T2DM. RESULTS: During the follow up period 402 (18%) patients experienced a new-onset MACE with hs-Tnl and BNP level significantly higher than in those without MACE. In multivariable analyses, patients with elevated hs-Tnl (hazard ratio, 1.75 95% CI 1.41-2.17; P < 0.001) and BNP (hazard ratio, 1.42 95% CI 1.15-1.75; P = 0.001) were significantly associated with an increased risk of MACE after adjustment for variables of a risk factor model of age, sex, T2DM and hypertension. The risk factor model had an AUC of 0.64 for MACE prediction. The AUC significantly increased to 0.68 by the addition of hs-Tnl to the risk factor model. Subgroup analyses showed that hs-Tnl and BNP remained significant predictors of MACE in both patients with and without T2DM in multivariable models with higher risk of MACE evident in those without T2DM. Among patients without T2DM, addition of each biomarker yielded greater predictive accuracy than in T2DM patients, with AUC further increased to 0.75 when a combination of hs-Tnl and BNP was added to the risk factor model (age, sex and hypertension). CONCLUSIONS: Elevated hs-Tnl and BNP level are independent predictors of new-onset MACE in CAD patients, irrespective of diabetes status. Among CAD patients without T2DM, a combination of cardiac biomarkers hs-Tnl and BNP yield the greatest predictive value beyond conventional risk factors.
Wong et al. (Sun,) conducted a cohort in Stable coronary artery disease (n=2,275). Elevated high-sensitivity troponin I (hs-TnI) and B-type natriuretic peptide (BNP) vs. Biomarker levels below cutoffs was evaluated on New-onset major adverse cardiovascular events (MACE) (HR 1.75, 95% CI 1.41-2.17, p=<0.001). Elevated baseline levels of high-sensitivity troponin I (HR 1.75) and B-type natriuretic peptide (HR 1.42) independently increased the risk of major adverse cardiovascular events in patients with stable coronary artery disease.