Relation of High-Sensitivity Cardiac Troponin I and Obstructive Coronary Artery Disease in Patients Without Acute
Reza Mohebi1, Laurel Jackson2, Cian P McCarthy1
1Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Insights
High-sensitivity cardiac troponin I (hs-cTnI) levels can help detect coronary artery disease (CAD) in patients without myocardial infarction (MI). Higher hs-cTnI is linked to CAD presence and future cardiovascular events.
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Medicine
Background:
- The relationship between high-sensitivity cardiac troponin I (hs-cTnI) and obstructive coronary artery disease (CAD) in patients without myocardial infarction (MI) requires clarification.
- hs-cTnI is a sensitive marker for myocardial injury, but its role in diagnosing CAD in non-MI patients is less understood.
Purpose of the Study:
- To investigate the association between hs-cTnI concentration and the presence of obstructive CAD in patients without acute MI.
- To evaluate the predictive value of hs-cTnI for future adverse cardiovascular (CV) outcomes in this population.
Main Methods:
- A gradient boosting model was developed to detect CAD using hs-cTnI and other clinical factors.
- Cox proportional hazard regression analysis assessed the link between hs-cTnI and adverse CV events.
- Study included 978 patients without MI who underwent coronary angiography.
Main Results:
- 607 patients (62%) had CAD. Higher hs-cTnI concentrations correlated with CAD, chronic kidney disease, heart failure, and other risk factors.
- The gradient boosting model achieved an AUC of 0.82 for CAD detection.
- Elevated hs-cTnI was significantly associated with increased risk of incident MI, CV mortality, and composite CV events (HRs ranging from 1.24 to 1.34).
Conclusions:
- In patients without acute MI, elevated hs-cTnI levels are associated with the presence of obstructive CAD.
- Higher hs-cTnI concentrations predict an increased risk of future cardiovascular events, including MI and CV mortality.
Abstract:
The relation of high-sensitivity cardiac troponin I (hs-cTnI) concentration and presence of obstructive coronary artery disease (CAD) in patients without myocardial infarction (MI) is unclear. Study participants selected from patients free of MI who underwent coronary angiography with or without intervention were enrolled, and hs-cTnI measured. A gradient boosting model was implemented to build a model for detection of CAD. Cox proportional hazard regression was used to assess the association of hs-cTnI and adverse cardiovascular (CV) outcome. Among 978 study participants, 607 patients (62%) had CAD. Higher concentrations of hs-cTnI were associated with chronic kidney disease, heart failure, CAD, male gender, current tobacco use, anemia, age, and low-density lipoprotein cholesterol. History of CAD, male gender, type 2 diabetes mellitus, hs-cTnI, anemia, age, and high-density lipoprotein cholesterol were the most influential factors for detection of CAD. The gradient boosting model had an area under the curve of 0.82, accuracy of 75%, sensitivity of 88%, specificity of 52%, positive predictive value of 76%, and negative predictive value of 72% for detection of CAD. Increase in 1 log unit of hs-cTnI was significantly associated with increased risk of incident MI (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.22 to 1.47, p <0.001), CV mortality (HR 1. 24, 95% CI 1.11 to 1.39, p <0.001), and composite of incident MI or CV mortality (HR 1.29, 95% CI 1.20 to 1.40, p <0.001). In conclusion, among patients without acute MI and CAD, higher concentrations of hs-cTnI were associated with the presence of CAD and linked to increased risk of future CV events. ClinicalTrials.gov Identifier: NCT00842868.
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