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Published on: June 16, 2014
Comparison of the Association Between High-Sensitivity Troponin I and Adverse Cardiovascular Outcomes in Patients
Pratik B Sandesara1, Wesley T O'Neal1, Ayman Samman Tahhan1
1Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Insights
High-sensitivity troponin I (hs-TnI) predicts adverse cardiovascular events more strongly in patients with chronic kidney disease (CKD). This finding highlights the need for aggressive risk factor modification in CKD patients identified as high-risk by hs-TnI.
Area of Science:
- Cardiology
- Nephrology
- Biomarkers
Background:
- Chronic kidney disease (CKD) is associated with increased cardiovascular risk.
- The prognostic value of high-sensitivity troponin I (hs-TnI) in patients with CKD is not well-established.
- Understanding hs-TnI's predictive power across the CKD spectrum is crucial for risk stratification.
Purpose of the Study:
- To investigate whether the association between hs-TnI and adverse cardiovascular outcomes differs in patients with and without CKD.
- To determine if hs-TnI can identify high-risk individuals within the CKD population.
- To assess the role of hs-TnI in predicting mortality, cardiovascular death, and MACE in patients undergoing coronary angiography.
Main Methods:
- Analysis of 4,107 patients from the Emory Cardiovascular Biobank who underwent coronary angiography.
- Definition of CKD based on estimated glomerular filtration rate (<60 mL/min/1.73 m²) or urine albumin/creatinine ratio (>30 mg/g).
- Cox regression models used to calculate hazard ratios for hs-TnI (per doubling) and adverse cardiovascular outcomes (death, cardiovascular death, MACE), with interaction analyses for CKD status.
Main Results:
- Hs-TnI was a stronger predictor of death in patients with CKD compared to those without (p-interaction=0.023).
- The association between hs-TnI and death was significantly stronger in CKD patients without obstructive coronary artery disease (p-interaction=0.041).
- Hs-TnI demonstrated a trend towards stronger prediction of cardiovascular death (p-interaction=0.12) and MACE (p-interaction=0.095) in CKD patients.
Conclusions:
- Hs-TnI is a more potent predictor of adverse cardiovascular events in patients with CKD than in those without.
- Hs-TnI can identify high-risk CKD patients, including those without obstructive coronary artery disease, who may benefit from intensified risk factor management.
- These findings underscore the importance of hs-TnI in cardiovascular risk assessment for CKD patients.
Abstract:
It is unknown whether the association of high-sensitivity troponin I (hs-TnI) with adverse cardiovascular outcomes varies by the presence of chronic kidney disease (CKD). We examined the association of hs-TnI with adverse cardiovascular outcomes in those with and without CKD in 4,107 (mean age, 64 years; 63% men; 20% black) patients from the Emory Cardiovascular Biobank who underwent coronary angiography. CKD (n = 1,073) was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2 or urine albumin/creatinine ratio >30 mg/g at baseline. Cox regression was used to compute hazard ratios (HR) for the association between hs-TnI levels (per doubling of hs-TnI: log2[hs-TnI] + 1) and death, cardiovascular death, and major adverse cardiac events (MACE), separately. Hs-TnI was a stronger predictor of death (CKD: HR 1.23, 95% confidence interval [CI] 1.15 to 1.31; no CKD: HR 1.11, 95% CI 1.05 to 1.17, p-interaction = 0.023), cardiovascular death (CKD: HR 1.24, 95% CI 1.14 to 1.34; no CKD: HR 1.15, 95% CI 1.07 to 1.22, p-interaction = 0.12), and MACE (CKD: HR 1.18, 95% CI 1.11 to 1.25; no CKD: HR 1.11, 95% CI 1.06 to 1.16, p-interaction = 0.095) in CKD compared with non-CKD. The association between hs-TnI and death in patients with CKD was stronger for patients without obstructive coronary artery disease (no obstructive coronary artery disease: HR 1.60, 95% CI 1.27 to 2.01; obstructive coronary artery disease: HR 1.19, 95% CI 1.11 to 1.27, p-interaction = 0.041). In conclusion, hs-TnI is a stronger predictor of adverse cardiovascular events in patients who have CKD than those without, even in the absence of obstructive coronary artery disease. Hs-TnI may identify CKD patients who are high risk for adverse cardiovascular outcomes in whom aggressive risk factor modification strategies are warranted.
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