Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 61, Issue 12, Pages 1240-1249Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2012.12.026
Keywords
cardiovascular death; coronary artery disease; natriuretic peptides; troponin
Categories
Funding
- National Heart, Lung, and Blood Institute with support from Knoll Pharmaceuticals and Abbott Laboratories
- Abbott Diagnostics and Roche Diagnostics
- Abbott Diagnostics and Roche Diagnostics through Akershus University Hospital
- Amgen
- Anthera
- AstraZeneca
- Biogen
- Boehringer Ingelheim
- Boston Scientific
- Bristol-Myers Squibb
- Cytokinetics
- Daiichi-Sankyo
- Genzyme
- Gilead
- GlaxoSmithKline
- Medtronic
- Nicox
- Novartis
- Roche
- Salutria
- Sanofi-Aventis
- Servier
- University of Oxford
- VIA Pharmaceutics
- Abbott
- Baxter
- Celladon
- Abbott Laboratories
- BRAHMS
- Critical Diagnostics
- Roche Diagnostics through Brigham
- Women's Hospital
- Knoll Pharmaceuticals
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Objectives The aims of this study were to assess the prognostic value of cardiac troponin I levels, measured with a new high-sensitivity assay, in low-risk patients with stable coronary artery disease (CAD) and to contrast its determinants and prognostic merit with that of high-sensitivity cardiac troponin T (hs-TnT). Background New, highly sensitive cardiac troponin assays permit evaluation of the association between troponin levels and outcomes in patients with stable CAD. Methods High-sensitivity cardiac troponin I (hs-TnI) levels at baseline were assessed in 3,623 patients with stable CAD and preserved systolic function enrolled in the PEACE (Prevention of Events With Angiotensin-Converting Enzyme Inhibitor Therapy) trial. Results In total, 98.5% of patients had hs-TnI concentrations higher than the detection level (1.2 pg/ml). hs-TnI correlated moderately with hs-TnT (r = 0.44) and N-terminal pro-B-type natriuretic peptide (r = 0.39) but only weakly with age (r = 0.17) and estimated glomerular filtration rate (r = -0.11). During a median follow-up period of 5.2 years, 203 patients died of cardiovascular causes or were hospitalized for heart failure, and 209 patients had nonfatal myocardial infarctions. In analyses adjusting for conventional risk markers, N-terminal pro-B-type natriuretic peptide, and hs-TnT, hs-TnI levels in the fourth compared with the 3 lower quartiles were associated with the incidence of cardiovascular death or heart failure (hazard ratio: 1.88; 95% confidence interval: 1.33 to 2.66; p < 0.001). There was a significant, albeit weaker association with nonfatal myocardial infarction (hazard ratio: 1.44; 95% confidence interval: 1.03 to 2.01; p = 0.031). In the same models, hs-TnT concentrations were associated with the incidence of cardiovascular death or heart failure but not of myocardial infarction. Conclusions In patients with stable CAD, hs-TnI concentrations are associated with cardiovascular risk independently of conventional risk markers and hs-TnT. (Prevention of Events With Angiotensin-Converting Enzyme Inhibitor Therapy [PEACE]; NCT00000558) (J Am Coll Cardiol 2013;61:1240-9) (C) 2013 by the American College of Cardiology Foundation
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