Troponin and Cardiac Events in Stable Ischemic Heart Disease and Diabetes

Area of Science:

• Cardiology
• Diabetology
• Biomarker Research

Background:

• Cardiac troponin concentrations are established biomarkers for acute coronary syndromes.
• Their utility in stable ischemic heart disease (SIHD) for risk stratification and guiding revascularization is less defined.
• This study investigates troponin T's role in patients with type 2 diabetes and SIHD.

Purpose of the Study:

• To assess the association between baseline cardiac troponin T (cTnT) concentration and cardiovascular events in patients with type 2 diabetes and SIHD.
• To determine if elevated cTnT identifies a subgroup that benefits from prompt coronary revascularization.

Main Methods:

• High-sensitivity troponin T assay used in 2285 patients from the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes (BARI 2D) trial.
• Association tested between baseline cTnT and a composite endpoint of cardiovascular death, myocardial infarction, or stroke.
• Subgroup analysis evaluated benefit of prompt revascularization in patients with abnormal cTnT (≥14 ng/L).

Main Results:

• Nearly all patients (99.6%) had detectable cTnT; 39.3% had abnormal levels (≥14 ng/L).
• Abnormal baseline cTnT was associated with a significantly higher 5-year composite endpoint rate (27.1% vs 12.9%) and increased risk (HR 1.85; P<0.001) after adjustment.
• Prompt revascularization did not significantly reduce the composite endpoint in patients with abnormal cTnT compared to medical therapy (HR 0.96).

Conclusions:

• Cardiac troponin T is an independent predictor of adverse cardiovascular outcomes in type 2 diabetes patients with SIHD.
• An elevated troponin T level (≥14 ng/L) does not identify patients who benefit from prompt coronary revascularization.
• Risk stratification using cTnT may be valuable, but revascularization decisions require further consideration in this population.