Prognostic value of cardiac troponin i measured with a highly sensitive assay in patients with stable coronary artery disease

Torbjørn Omland, Marc A. Pfeffer, Scott D. Solomon, James A de Lemos, Helge Røsjø, Jurate Šaltyte Benth, Aldo Maggioni, Michael J. Domanski, Jean L. Rouleau, Marc S. Sabatine, Eugene Braunwald

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194 Scopus citations

Abstract

Objectives: The aims of this study were to assess the prognostic value of cardiac troponin I levels, measured with a new high-sensitivity assay, in low-risk patients with stable coronary artery disease (CAD) and to contrast its determinants and prognostic merit with that of high-sensitivity cardiac troponin T (hs-TnT). Background: New, highly sensitive cardiac troponin assays permit evaluation of the association between troponin levels and outcomes in patients with stable CAD. Methods: High-sensitivity cardiac troponin I (hs-TnI) levels at baseline were assessed in 3,623 patients with stable CAD and preserved systolic function enrolled in the PEACE (Prevention of Events With Angiotensin- Converting Enzyme Inhibitor Therapy) trial. Results: In total, 98.5% of patients had hs-TnI concentrations higher than the detection level (1.2 pg/ml). hs-TnI correlated moderately with hs-TnT (r = 0.44) and N-terminal pro-B-type natriuretic peptide (r = 0.39) but only weakly with age (r = 0.17) and estimated glomerular filtration rate (r = -0.11). During a median follow-up period of 5.2 years, 203 patients died of cardiovascular causes or were hospitalized for heart failure, and 209 patients had nonfatal myocardial infarctions. In analyses adjusting for conventional risk markers, N-terminal pro-B-type natriuretic peptide, and hs-TnT, hs-TnI levels in the fourth compared with the 3 lower quartiles were associated with the incidence of cardiovascular death or heart failure (hazard ratio: 1.88; 95% confidence interval: 1.33 to 2.66; p < 0.001). There was a significant, albeit weaker association with nonfatal myocardial infarction (hazard ratio: 1.44; 95% confidence interval: 1.03 to 2.01; p = 0.031). In the same models, hs-TnT concentrations were associated with the incidence of cardiovascular death or heart failure but not of myocardial infarction. Conclusions In patients with stable CAD, hs-TnI concentrations are associated with cardiovascular risk independently of conventional risk markers and hs-TnT.

Original languageEnglish (US)
Pages (from-to)1240-1249
Number of pages10
JournalJournal of the American College of Cardiology
Volume61
Issue number12
DOIs
StatePublished - Mar 26 2013

Keywords

  • Cardiovascular death
  • Coronary artery disease
  • Natriuretic Peptides
  • Troponin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Omland, T., Pfeffer, M. A., Solomon, S. D., de Lemos, J. A., Røsjø, H., Benth, J. Š., Maggioni, A., Domanski, M. J., Rouleau, J. L., Sabatine, M. S., & Braunwald, E. (2013). Prognostic value of cardiac troponin i measured with a highly sensitive assay in patients with stable coronary artery disease. Journal of the American College of Cardiology, 61(12), 1240-1249. https://doi.org/10.1016/j.jacc.2012.12.026