Elevated hs-cTnT >14 ng/l was strongly associated with all-cause mortality (HR 12.9; 95% CI 3.5-46.9; p=0.0001) and a composite clinical endpoint in stable ambulatory coronary artery disease patients.
Observational (n=693)
No
Does elevated hs-cTnT (>14 ng/l) predict all-cause mortality and adverse cardiovascular events in stable ambulatory coronary artery disease patients?
Elevated hs-cTnT levels (>14 ng/l) provide strong prognostic information for all-cause mortality and adverse cardiovascular events in stable ambulatory CAD outpatients.
Effect estimate: HR 12.9 (95% CI 3.5-46.9)
p-value: p=0.0001
AIMS: To investigate the prognostic implications of elevated high-sensitivity cardiac troponin T (hs-cTnT) values in presumably stable ambulatory coronary artery disease patients. METHODS AND RESULTS: We conducted a retrospective, single-centre pilot observational study in a low-risk population. All patients received routine measurement of hs-cTnT at index and follow-up visits. Endpoints were all-cause mortality and a composite of all-cause mortality, acute myocardial infarction, stroke and rehospitalization for acute coronary syndrome and heart failure. Nine hundred and sixty-five consecutive patients presenting to our outpatient clinic between June 2009 and June 2010 were screened; 693 patients with a stable clinical course, at least one hs-cTnT value and at least one follow-up visit qualified for analysis. Follow-up was 796 days. Five hundred and forty-seven patients (78.9%) had hs-cTnT values below and 146 patients (21.1%) had values above 14 ng/l, which was defined to categorize high and low levels as it was reported to be the 99th percentile of a reference population. We observed 13 deaths (all-cause mortality) including four cardiovascular deaths. Age, N terminal pro-brain natriuretic peptide levels and impaired renal function were independently associated with an elevated hs-cTnT in a multivariate analysis. Hs-cTnT values >14 ng/l were strongly associated with all-cause mortality (hazard ratio 12.9, 95% confidence interval (CI): 3.5-46.9, p=0.0001), the composite clinical endpoint (hazard ratio 2.35, 95% CI: 1.48-3.72, p=0.0003) and rehospitalization for heart failure (hazard ratio 3.36, 95% CI: 1.73-6.53, p=0.0004). Compared with the multivariable Framingham score hs-cTnT revealed a significantly better performance (area under the receiver operating characteristics curve (AUC) hs-cTnT: 0.882 vs. AUC Framingham score 0.639, p=0.0005). CONCLUSION: Elevated hs-cTnT levels provide excellent prognostic information regarding all-cause mortality and a combined clinical endpoint in presumably stable ambulatory coronary artery disease outpatients presenting for routine evaluation.
Biener et al. (Sex,) conduziram um estudo observacional em pacientes com doença arterial coronariana estável ambulatorial (n=693). A troponina T cardíaca de alta sensibilidade (hs-cTnT) elevada >14 ng/l vs. hs-cTnT ≤14 ng/l foi avaliada em mortalidade por todas as causas (HR 12,9, IC 95% 3,5-46,9, p=0,0001). A hs-cTnT elevada >14 ng/l foi fortemente associada com mortalidade por todas as causas (HR 12,9; IC 95% 3,5-46,9; p=0,0001) e um desfecho clínico composto em pacientes com doença arterial coronariana estável ambulatorial.