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High-Sensitivity Cardiac Troponin for Risk Assessment in Patients With Chronic Coronary Artery Disease
Ryan Wereski1, Philip Adamson2, Nur Shazlin Shek Daud3
1British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom. Electronic address: https://twitter.com/RyanWereski.
Insights
Cardiac troponin testing can identify patients with chronic coronary artery disease at higher risk of myocardial infarction or cardiovascular death. This risk prediction is independent of traditional risk factors and disease severity, aiding in treatment decisions.
Area of Science:
- Cardiology
- Biomarkers
- Risk Stratification
Background:
- Cardiac troponin is established for acute coronary syndrome risk stratification.
- Its utility in other clinical settings, like chronic coronary artery disease, is less clear.
Purpose of the Study:
- To assess if cardiac troponin testing improves risk stratification in chronic coronary artery disease patients.
- To determine if this is independent of disease severity and conventional risk factors.
Main Methods:
- Prospective cohort study of 4,240 patients undergoing coronary angiography for stable angina symptoms.
- High-sensitivity cardiac troponin I measured pre-angiography, with clinicians blinded to results.
- Primary outcome: myocardial infarction or cardiovascular death over a median follow-up of 2.4 years.
Main Results:
- In 3,888 patients with coronary artery disease, 255 experienced primary outcome events.
- Troponin levels were twofold higher in patients with events (6.7 ng/L vs 3.3 ng/L).
- Elevated troponin predicted outcomes independently (aHR 2.3), with levels >10 ng/L indicating a 50% increased risk.
Conclusions:
- Cardiac troponin predicts myocardial infarction or cardiovascular death risk in chronic coronary artery disease, independent of other factors.
- Further research is needed to explore routine troponin testing for guiding treatment intensification in high-risk patients.
Background:
Cardiac troponin is used for risk stratification of patients with acute coronary syndromes; however, the role of testing in other settings remains unclear.
Objectives:
The aim of this study was to evaluate whether cardiac troponin testing could enhance risk stratification in patients with chronic coronary artery disease independent of disease severity and conventional risk measures.
Methods:
In a prospective cohort of consecutive patients with symptoms suggestive of stable angina attending for outpatient coronary angiography, high-sensitivity cardiac troponin I was measured before angiography, and clinicians were blinded to the results. The primary outcome was myocardial infarction or cardiovascular death during follow-up.
Results:
In 4,240 patients (age 66 years [IQR: 59-73 years], 33% female), coronary artery disease was identified in 3,888 (92%) who had 255 (6%) primary outcome events during a median follow-up of 2.4 years (IQR: 1.3-3.6 years). In patients with coronary artery disease, troponin concentrations were 2-fold higher in those with an event compared with those without (6.7 ng/L [IQR: 3.2-14.2 ng/L] vs 3.3 ng/L [IQR: 1.7-6.6 ng/L]; P < 0.001). Troponin concentrations were associated with the primary outcome after adjusting for cardiovascular risk factors and coronary artery disease severity (adjusted HR: 2.3; 95% CI: 1.7-3.0, log10 troponin; P < 0.001). A troponin concentration >10 ng/L identified patients with a 50% increase in the risk of myocardial infarction or cardiovascular death.
Conclusions:
In patients with chronic coronary artery disease, cardiac troponin predicts risk of myocardial infarction or cardiovascular death independent of cardiovascular risk factors and disease severity. Further studies are required to evaluate whether routine testing could inform the selection of high-risk patients for treatment intensification. (Myocardial Injury in Patients Referred for Coronary Angiography [MICA]; ISRCTN15620297).
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