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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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

Fingerprint

Troponin
Troponin I
Coronary Artery Disease
Troponin T
Heart Failure
Brain Natriuretic Peptide
Myocardial Infarction
Confidence Intervals
Enzyme Therapy
Incidence
Glomerular Filtration Rate
Angiotensin-Converting Enzyme Inhibitors

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic value of cardiac troponin i measured with a highly sensitive assay in patients with stable coronary artery disease. / Omland, Torbjørn; Pfeffer, Marc A.; Solomon, Scott D.; de Lemos, James A; Røsjø, Helge; Benth, Jurate Šaltyte; Maggioni, Aldo; Domanski, Michael J.; Rouleau, Jean L.; Sabatine, Marc S.; Braunwald, Eugene.

In: Journal of the American College of Cardiology, Vol. 61, No. 12, 26.03.2013, p. 1240-1249.

Research output: Contribution to journalArticle

Omland, T, Pfeffer, MA, Solomon, SD, de Lemos, JA, Røsjø, H, Benth, JŠ, Maggioni, A, Domanski, MJ, Rouleau, JL, Sabatine, MS & 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, vol. 61, no. 12, pp. 1240-1249. https://doi.org/10.1016/j.jacc.2012.12.026
Omland, Torbjørn ; Pfeffer, Marc A. ; Solomon, Scott D. ; de Lemos, James A ; Røsjø, Helge ; Benth, Jurate Šaltyte ; Maggioni, Aldo ; Domanski, Michael J. ; Rouleau, Jean L. ; Sabatine, Marc S. ; Braunwald, Eugene. / Prognostic value of cardiac troponin i measured with a highly sensitive assay in patients with stable coronary artery disease. In: Journal of the American College of Cardiology. 2013 ; Vol. 61, No. 12. pp. 1240-1249.
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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.",
keywords = "Cardiovascular death, Coronary artery disease, Natriuretic Peptides, Troponin",
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T1 - Prognostic value of cardiac troponin i measured with a highly sensitive assay in patients with stable coronary artery disease

AU - Omland, Torbjørn

AU - Pfeffer, Marc A.

AU - Solomon, Scott D.

AU - de Lemos, James A

AU - Røsjø, Helge

AU - Benth, Jurate Šaltyte

AU - Maggioni, Aldo

AU - Domanski, Michael J.

AU - Rouleau, Jean L.

AU - Sabatine, Marc S.

AU - Braunwald, Eugene

PY - 2013/3/26

Y1 - 2013/3/26

N2 - 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.

AB - 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.

KW - Cardiovascular death

KW - Coronary artery disease

KW - Natriuretic Peptides

KW - Troponin

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