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Single-Molecule hsTnI and Short-Term Risk in Stable Patients With Chest Pain

James L Januzzi1, Sunil Suchindran2, Udo Hoffmann3

  • 1Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts; Baim Institute for Clinical Research, Boston, Massachusetts.

Journal of the American College of Cardiology
|January 26, 2019
PubMed

Insights

High-sensitivity troponin I (hsTnI) levels within the normal range can predict near-term cardiac events in patients with suspected coronary artery disease (CAD). This troponin testing aids in assessing risk for death or myocardial infarction (MI).

Area of Science:

  • Cardiology
  • Biomarker Research
  • Clinical Diagnostics

Background:

  • Evaluating stable outpatients with suspected coronary artery disease (CAD) presents challenges due to varied cardiovascular risk.
  • The utility of troponin testing in this specific clinical setting remains largely unexplored.

Purpose of the Study:

  • To investigate the prognostic value of single-molecule counting high-sensitivity troponin I (hsTnI) in outpatients with stable chest symptoms and suspected CAD.
  • To determine if hsTnI levels, even within the normal range, can predict adverse cardiovascular outcomes.

Main Methods:

  • Analysis of hsTnI results from 4,021 participants in the PROMISE study with available blood samples.
  • hsTnI levels were assessed against the primary outcome of death, acute myocardial infarction (MI), or hospitalization for unstable angina within one year.
  • Multivariable models were used to evaluate hsTnI as an independent predictor of outcomes.

Main Results:

  • A median hsTnI value of 1.6 ng/L was observed, with measurable concentrations in 98.6% of participants.
  • Higher hsTnI concentrations, even within the normal range (<6 ng/L), were associated with increased risk of major adverse cardiovascular events.
  • hsTnI independently predicted death, MI, or hospitalization (HR 1.54) and cardiovascular death or MI (HR 1.52), particularly for near-term events.

Conclusions:

  • Elevated hsTnI levels within the normal range are linked to increased near-term risk of adverse cardiovascular events in symptomatic outpatients with suspected CAD.
  • hsTnI testing can provide valuable prognostic information for risk stratification in this patient population.
Abstract

Keywords:
chest painstable anginatroponin

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