TY - JOUR
T1 - Single-Molecule Counting of High-Sensitivity Troponin I in Patients Referred for Diagnostic Angiography
T2 - Results From the CASABLANCA (Catheter Sampled Blood Archive in Cardiovascular Diseases) Study
AU - McCarthy, Cian P.
AU - Ibrahim, Nasrien E.
AU - Lyass, Asya
AU - Li, Yiwei
AU - Gaggin, Hanna K.
AU - Simon, Mandy L.
AU - Mukai, Renata
AU - Gandhi, Parul
AU - Kelly, Noreen
AU - Motiwala, Shweta R.
AU - van Kimmenade, Roland R. J.
AU - Massaro, Joseph M.
AU - D'Agostino, Ralph B.
AU - Januzzi, James L.
N1 - © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2018/3/8
Y1 - 2018/3/8
N2 - BACKGROUND: The meaning of high-sensitivity troponin I (hsTnI) concentrations in patients without acute myocardial infarction (MI) requires clarity. We hypothesized that among patients referred for diagnostic coronary angiography without acute MI, hsTnI concentrations would correlate with prevalent coronary artery disease (CAD) and predict incident cardiovascular events and mortality.METHODS AND RESULTS: We measured hsTnI using a single-molecule counting assay (99th percentile, 6 ng/L) in samples from 991 patients obtained at the time of angiography. Concentrations of hsTnI were assessed relative to the severity of CAD and prognosis during mean follow-up of 3.7 years. Median hsTnI concentration was 4.19 ng/L; 38% of patients had hsTnI concentrations ≥99th percentile. Across increasing hsTnI quartiles, patients had higher prevalence of angiographic CAD; in multivariate models, hsTnI ≥99th percentile independently predicted obstructive CAD (odds ratio: 2.57;
P<0.001) and incident MI (hazard ratio [HR]: 2.68;
P<0.001), cardiovascular death (HR: 2.29;
P=0.001), and all-cause death (HR: 1.84;
P=0.004). In those with >70% coronary stenosis, hsTnI ≥99th percentile independently predicted incident MI (HR: 1.87;
P=0.01), cardiovascular mortality (HR: 2.74;
P=0.001), and the composite end point of MI and all-cause death (HR: 2.06;
P<0.001). In participants with coronary stenosis <70%, hsTnI ≥99th percentile even more strongly predicted incident MI (HR: 8.41;
P<0.001), cardiovascular mortality (HR: 3.60;
P=0.03), and the composite end point of MI and all-cause death (HR: 3.62;
P<0.001).
CONCLUSIONS: In a large prospective cohort of patients who were free of prevalent MI and undergoing diagnostic coronary angiography, hsTnI concentrations were associated with higher prevalence of CAD and predicted incident MI, cardiovascular death, and all-cause death.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00842868.
AB - BACKGROUND: The meaning of high-sensitivity troponin I (hsTnI) concentrations in patients without acute myocardial infarction (MI) requires clarity. We hypothesized that among patients referred for diagnostic coronary angiography without acute MI, hsTnI concentrations would correlate with prevalent coronary artery disease (CAD) and predict incident cardiovascular events and mortality.METHODS AND RESULTS: We measured hsTnI using a single-molecule counting assay (99th percentile, 6 ng/L) in samples from 991 patients obtained at the time of angiography. Concentrations of hsTnI were assessed relative to the severity of CAD and prognosis during mean follow-up of 3.7 years. Median hsTnI concentration was 4.19 ng/L; 38% of patients had hsTnI concentrations ≥99th percentile. Across increasing hsTnI quartiles, patients had higher prevalence of angiographic CAD; in multivariate models, hsTnI ≥99th percentile independently predicted obstructive CAD (odds ratio: 2.57;
P<0.001) and incident MI (hazard ratio [HR]: 2.68;
P<0.001), cardiovascular death (HR: 2.29;
P=0.001), and all-cause death (HR: 1.84;
P=0.004). In those with >70% coronary stenosis, hsTnI ≥99th percentile independently predicted incident MI (HR: 1.87;
P=0.01), cardiovascular mortality (HR: 2.74;
P=0.001), and the composite end point of MI and all-cause death (HR: 2.06;
P<0.001). In participants with coronary stenosis <70%, hsTnI ≥99th percentile even more strongly predicted incident MI (HR: 8.41;
P<0.001), cardiovascular mortality (HR: 3.60;
P=0.03), and the composite end point of MI and all-cause death (HR: 3.62;
P<0.001).
CONCLUSIONS: In a large prospective cohort of patients who were free of prevalent MI and undergoing diagnostic coronary angiography, hsTnI concentrations were associated with higher prevalence of CAD and predicted incident MI, cardiovascular death, and all-cause death.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00842868.
KW - biomarkers
KW - coronary artery disease
KW - high-sensitivity
KW - troponin
KW - CORONARY-ARTERY-DISEASE
KW - C-REACTIVE PROTEIN
KW - HEART-DISEASE
KW - CARDIAC TROPONIN
KW - MYOCARDIAL-INFARCTION
KW - EVENTS
KW - OUTPATIENTS
U2 - 10.1161/JAHA.117.007975
DO - 10.1161/JAHA.117.007975
M3 - Article
C2 - 29519811
SN - 2047-9980
VL - 7
SP - 1
EP - 57
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 6
M1 - 007975
ER -