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Single-Molecule Counting of High-Sensitivity Troponin I in Patients Referred for Diagnostic Angiography: Results From
Cian P McCarthy1, Nasrien E Ibrahim2, Asya Lyass3
1Department of Medicine, Massachusetts General Hospital, Boston, MA.
Insights
High-sensitivity troponin I (hsTnI) levels in patients without acute myocardial infarction (MI) correlate with coronary artery disease (CAD) and predict future cardiovascular events and mortality.
Area of Science:
- Cardiology
- Biomarkers
- Preventive Medicine
Background:
- High-sensitivity troponin I (hsTnI) interpretation in patients without acute myocardial infarction (MI) needs clarification.
- The study investigates the prognostic value of hsTnI in individuals undergoing coronary angiography without acute MI.
Purpose of the Study:
- To determine if hsTnI concentrations correlate with prevalent coronary artery disease (CAD) in patients without acute MI.
- To assess the predictive value of hsTnI for incident cardiovascular events and mortality in this population.
Main Methods:
- hsTnI was measured using a single-molecule counting assay in 991 patients undergoing diagnostic coronary angiography.
- hsTnI concentrations were analyzed in relation to CAD severity and patient prognosis over a mean follow-up of 3.7 years.
Main Results:
- Elevated hsTnI (≥99th percentile) was independently associated with obstructive CAD (OR: 2.57) and predicted incident MI (HR: 2.68), cardiovascular death (HR: 2.29), and all-cause death (HR: 1.84).
- hsTnI independently predicted adverse outcomes, including MI and mortality, even in patients with less than 70% coronary stenosis, with hazard ratios ranging from 3.60 to 8.41.
Conclusions:
- In patients without prevalent MI undergoing coronary angiography, hsTnI concentrations are linked to a higher prevalence of CAD.
- hsTnI predicts incident MI, cardiovascular death, and all-cause mortality, highlighting its prognostic utility beyond acute MI diagnosis.
Background:
The meaning of high-sensitivity troponin I (hsTnI) concentrations in patients without acute myocardial infarction (MI) requires clarity. We hypothesized that among patients referred for diagnostic coronary angiography without acute MI, hsTnI concentrations would correlate with prevalent coronary artery disease (CAD) and predict incident cardiovascular events and mortality.
Methods And Results:
We measured hsTnI using a single-molecule counting assay (99th percentile, 6 ng/L) in samples from 991 patients obtained at the time of angiography. Concentrations of hsTnI were assessed relative to the severity of CAD and prognosis during mean follow-up of 3.7 years. Median hsTnI concentration was 4.19 ng/L; 38% of patients had hsTnI concentrations ≥99th percentile. Across increasing hsTnI quartiles, patients had higher prevalence of angiographic CAD; in multivariate models, hsTnI ≥99th percentile independently predicted obstructive CAD (odds ratio: 2.57; P<0.001) and incident MI (hazard ratio [HR]: 2.68; P<0.001), cardiovascular death (HR: 2.29; P=0.001), and all-cause death (HR: 1.84; P=0.004). In those with >70% coronary stenosis, hsTnI ≥99th percentile independently predicted incident MI (HR: 1.87; P=0.01), cardiovascular mortality (HR: 2.74; P=0.001), and the composite end point of MI and all-cause death (HR: 2.06; P<0.001). In participants with coronary stenosis <70%, hsTnI ≥99th percentile even more strongly predicted incident MI (HR: 8.41; P<0.001), cardiovascular mortality (HR: 3.60; P=0.03), and the composite end point of MI and all-cause death (HR: 3.62; P<0.001).
Conclusions:
In a large prospective cohort of patients who were free of prevalent MI and undergoing diagnostic coronary angiography, hsTnI concentrations were associated with higher prevalence of CAD and predicted incident MI, cardiovascular death, and all-cause death.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00842868.
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