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Prognostic utility of high-sensitivity troponins according to atherosclerotic vascular disease severity
Julia Rohde1, Fabian J Brunner2, Alina Goßling3
1Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
High-sensitivity troponin T and I (hsTnT/I) predict all-cause mortality in patients with atherosclerotic vascular disease (ASVD), especially polyvascular disease (PolyVD). These biomarkers are valuable for risk stratification in ASVD patients.
Area of Science:
- Cardiology
- Biomarkers
- Vascular Disease
Background:
- Polyvascular disease (PolyVD), defined as atherosclerotic vascular disease (ASVD) in multiple vascular beds, confers a high risk of adverse outcomes.
- The prognostic value of high-sensitivity troponin T and I (hsTnT/I) in PolyVD patients remains under-explored.
Purpose of the Study:
- To investigate the association between hsTnT/I levels and the extent of ASVD.
- To explore the prognostic utility of hsTnT/I in predicting clinical outcomes in patients with ASVD.
Main Methods:
- Analysis of hsTnT/I concentrations in 2273 patients undergoing coronary angiography from the INTERCATH cohort study.
- Stratification into subgroups: no ASVD, monovascular disease (MVD), and PolyVD.
- Cox regression analyses to assess the relationship between hsTnT/I, ASVD extent, and outcomes (all-cause mortality, major adverse cardiovascular events [MACE]).
Main Results:
- A stepwise increase in hsTnT and hsTnI was observed with increasing ASVD extent, though not statistically significant after adjustment.
- hsTnT and hsTnI were independently associated with all-cause mortality in both PolyVD and MVD patients.
- No significant association was found between hsTn levels and MACE across the spectrum of ASVD burden.
Conclusions:
- Higher hsTnT/I concentrations correlate with a greater extent of ASVD and increased incidence of all-cause mortality and MACE.
- hsTnT/I levels are reliably linked to all-cause mortality in ASVD patients.
- Biomarkers like hsTnT/I play a crucial role in enhancing risk prediction for patients with atherosclerotic vascular disease.
Background And Aims:
Patients with atherosclerotic vascular disease (ASVD) affecting two or more different vascular beds, so called Polyvascular disease (PolyVD), are at an increased risk for adverse outcomes. In those patients, the prognostic utility of high-sensitivity troponin T and I (hsTnT/I) is under-investigated. We therefore aimed to explore the association between hsTnT/I with the extent of ASVD and outcomes in a contemporary cohort.
Methods:
Patients undergoing coronary angiography with available hsTnT/I concentrations from the cohort study INTERCATH were included. Subgroups of patients without ASVD, monovascular disease (MVD), and PolyVD were created. Cox regression analyses were computed to investigate the associations of hsTnT/I with the extent of ASVD and clinical outcomes (all-cause mortality and major adverse cardiovascular events; MACE).
Results:
In 2273 included patients, a stepwise increase of both hsTnT and hsTnI was observed according to the extent of ASVD. However, this association was statistically not significant after adjustment. hsTnT and hsTnI were independently associated with all-cause mortality for PolyVD (adjusted hazard ratio per standard deviation for hsTnT: 1.42 [95 %-CI: 1.16, 1.73]; p < 0.001 and hsTnI: 1.38 [1.14, 1.68]; p = 0.0013) and MVD (hsTnT: 1.32 [1.15, 1.51]; p < 0.001 and hsTnI: 1.35 [1.17, 1.56]; p < 0.001), whereas no association of hsTn with MACE was seen across the burden of ASVD.
Conclusions:
Patients with a greater extent of ASVD had higher concentrations of hsTnT/I and an increased incidence of all-cause mortality as well as MACE. hsTnT/I concentrations were reliably linked to all-cause mortality in patients with ASVD, underscoring the role of biomarkers in risk prediction.
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