Abstract 1031: Distribution of a Contemporary Sensitive Troponin I and Its Correlation With Cardiovascular Risk Factors in a Population Based Cohort
Background: The current universal definition of myocardial infarction recommends the use of the 99th percentile of population distribution as a cut-off for troponin. Whether this should be a general or a healthy population, regarding cardiac disease, is still a matter of discussion. Our aim was to assess the distribution of a contemporary sensitive troponin I and analyze association with cardiovascular risk factors (CVRF).
Methods: We measured troponin I with 10% coefficient of variation below the published 99th percentile (SIEMENS ultra assay) in 5000 individuals of the population based Gutenberg Heart Study. Based on presence or absence of cardiovascular risk factor and manifestations of myocardial diseases such as coronary artery disease, myocardial infarction, atrial fibrillation and heart failure, we analyzed subpopulations.
Results: The subgroups showed a difference in the 99th percentiles with the highest value (0.040 ng/mL) in the general population (n=5000), followed by a population without manifest cardiac disease (0.032 ng/mL, n=4499) and a group without CVRF (0.028 ng/mL, n=1027). The general and non-cardiac-disease groups differed among the prevalence of hypertension, diabetes, dyslipidemia and obesity. In the group with troponin I above 99th percentile (n=48) the prevalence of coronary artery disease (14.58% vs. 4.58%) and heart failure (4.17% vs. 1.54%) was higher than in general population. Among the risk factors, only age (p=0.007) and gender (for males p=0.025) moderately correlated with troponin I in the general population. Similarly, only age (p=0.048) in non-cardiac-disease group and gender (for females p=0.003) in non-CVRF group correlated with troponin I.
Conclusions: Distribution of troponin I differs between a general population, a population without manifest cardiac disease and a population without cardiovascular risk factors. Troponin elevation above the 99th percentile is strongly associated with prevalence of coronary artery disease or heart failure in the general population. As new troponin assays will be more sensitive, the exact definition of the population based 99th percentile cut-off for myocardial infarction is of great importance.