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High-sensitivity cardiac troponin for risk prediction in patients with and without coronary heart disease
Willibald Hochholzer1, Christian M Valina1, Christian Stratz1
1Universitaets-Herzzentrum Freiburg·Bad Krozingen, Klinik für Kardiologie und Angiologie II, Suedring 15, 79189 Bad Krozingen, Germany.
Insights
High-sensitivity troponin T (hsTnT) effectively predicts cardiovascular events in stable patients, regardless of coronary heart disease presence. hsTnT improves risk prediction when added to clinical models, aiding in better patient management.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Risk Prediction
Background:
- Elevated cardiac troponin levels in stable patients correlate with increased cardiovascular event risk.
- This association may stem from troponin's ability to detect minor myocardial necrosis due to subclinical coronary atherosclerosis.
- The study investigated whether high-sensitivity troponin T (hsTnT) predictive value depends on diagnosed coronary heart disease.
Purpose of the Study:
- To determine if the predictive value of hsTnT in stable patients is influenced by the presence or absence of coronary heart disease.
- To assess the utility of hsTnT in improving risk stratification for cardiovascular events.
Main Methods:
- 2046 stable patients undergoing elective coronary angiography were enrolled.
- HsTnT levels were measured pre-procedure; patients were followed for up to seven years.
- Primary endpoint: all-cause mortality or non-fatal myocardial infarction, adjusted for clinical predictors.
Main Results:
- 60% of patients had obstructive coronary heart disease.
- HsTnT independently predicted the primary endpoint (adjusted HR 1.33).
- Adding hsTnT to clinical models significantly improved risk discrimination and reclassification (c-statistic: 0.751 to 0.773; NRI=0.362).
Conclusions:
- HsTnT significantly enhances risk prediction for mortality and myocardial infarction in stable patients.
- This improvement is independent of whether coronary heart disease is clinically detected.
- HsTnT is a valuable tool for risk stratification in stable patients, irrespective of coronary anatomy.
Background:
In stable patients with unknown coronary anatomy, higher levels of cardiac troponin are associated with an increased risk of cardiovascular events. It was supposed that this association might be explained by the ability of cardiac troponin to detect minor myocardial necrosis which might be caused by subclinical coronary atherosclerosis. Thus, this analysis tested if the predictive value of high-sensitivity troponin T (hsTnT) in stable patients is dependent of the presence or absence of angiographically documented coronary heart disease.
Methods:
Stable patients undergoing elective coronary angiography were enrolled (n=2046). HsTnT was determined before diagnostic procedures. The patients were followed for up to seven years. Primary endpoint was all-cause mortality or non-fatal myocardial infarction. All endpoints were adjudicated by independent physicians. Results were adjusted to a clinical model including independent clinical predictors of the primary endpoint.
Results:
Out of the 2046 patients enrolled, 1236 (60%) had a diagnosis of obstructive coronary heart disease. HsTnT predicted independently the primary endpoint (adjusted HR 1.33, 95%-CI 1.21-1.46, P<0.001). The use of hsTnT in addition to the clinical model significantly improved discrimination (c-statistic: 0.751 to 0.773, P<0.001) as well as reclassification of the primary endpoint (NRI=0.362, P<0.001). This significant improvement persisted across various subsets and was independent of the presence of clinically detectable coronary heart disease and other variables.
Conclusion:
The use of hsTnT in addition to clinical variables significantly improves discrimination and reclassification of patients with respect to all-cause mortality or non-fatal myocardial infarction irrespective of the presence of clinically detectable coronary heart disease.
Clinical Trial Registration:
ClinicalTrials.gov (Identifier: NCT00457236).
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