Abstract 17392: High-Sensitivity Troponin T Predicts Recurrent Cardiovascular Disease Events in Stable Coronary Heart Disease Patients: 8-Year Follow-Up of the KAROLA Study
Purpose: The clinical relevance of only slightly elevated circulating troponin levels in patients with stable coronary heart disease (CHD) several weeks after an acute event has not been fully evaluated. We aimed to assess the predictive value of a new high-sensitivity troponin T assay (hsTnT) for recurrent cardiovascular disease (CVD) events in stable CHD patients, simultaneously controlling for a large number of potential confounders.
Methods: Plasma concentrations of hsTnT (Roche Elecsys 2010) were measured at baseline in a cohort of 1,050 patients aged 30-70 years with CHD. The Cox proportional hazards model was used to determine the prognostic value of hsTnT on a combined CVD endpoint after adjustment for covariates.
Results: The median hsTnT level was 10.9 ng/L (IQR 5.1-18.9). Elevated hsTnT levels were associated with higher age, history of hypertension, history of diabetes, a higher number of affected vessels, initial management of CHD, and left-ventricular dysfunction. In addition as determined by 12-lead routine ECG, rhythm disorders, and anterior wall infarction were associated with higher hsTnT levels. Furthermore, hsTnT was highly correlated with NT-proBNP and cystatin C (R=0.61 and R=0.32, respectively, both p-values <0.0001). During a median follow-up of 8.1 years, 150 patients (21.0%) experienced a fatal- or non-fatal secondary CVD event. In a multivariate model, hsTnT was associated with a hazard ratio (HR) for secondary CVD events of 2.83 (95% CI, 1.68-4.79) when extreme quartiles were compared. Further adjustment for cystatin C, NT-proBNP, and CRP attenuated the association only slightly (2.27; 95% CI, 1.31-3.95), p for trend <0.002). ROC analysis of a clinical model which included hsTnT to a baseline model showed a modest improvement in the AUC (0.69 vs 0.67).
Conclusions: Slightly elevated hsTnT levels in stable CHD patients are associated with a number of CVD disorders and predict long-term CVD events in these patients.
- © 2011 by American Heart Association, Inc.