Abstract 11559: Determination of Cardiac Troponin with a Single-Molecule High-Sensitivity Assay and Outcomes in Patients with Stable Coronary Artery Disease: Analysis from PROVE IT-TIMI 22
Cardiac troponin (cTn), an established biomarker in acute coronary syndromes (ACS), is also an emerging risk predictor in patients (pts) with stable ischemic heart disease (SIHD). We assessed the prognostic performance of cTn and the interaction with intensive vs. moderate statin therapy in a large cohort of well-characterized pts with SIHD using an investigational high-sensitivity cTn assay.
Methods: We measured cTnI (Erenna, Singulex, 99th%ile 9 pg/mL,‘S-TnI’) in 3,209 pts who had been stable without recurrent events through 30 days after an ACS and had been randomized to intensive or moderate statin therapy in PROVE IT-TIMI 22. Based on prior work, our primary event of interest was cardiovascular death (CVD) or heart failure (HF). Pts were followed for an average of 2 years.
Results: All pts had detectable S-TnI and 970 (30.2%) pts had S-TnI above 99th%ile. Pts with elevated S-TnI were at higher risk of CVD/HF (6.2% v. 2.9%, p<0.001; HR 2.29, CI 1.62-3.23; Fig-middle). After adjustment for clinical covariates, including age, sex, DM, HTN, index event, CHF, and CrCl, S-TnI remained a significant predictor of CVD/HF (Adj HR 1.79, CI 1.21-2.64). Moreover, in the 69.8% of pts below the 99th %ile (9 pg/mL), S-TnI revealed a gradient of risk of CVD/HF (T1-T3; 1.7%, 2.9%, 4.1%; p<0.001; Fig-L). Among pts with elevated S-TnI, those randomized to intensive vs. moderate statin therapy had a significantly lower risk of CVD/HF (4.5% v. 8.0%, HR 0.59, CI 0.35-0.97, p=0.038, Fig-R).
Conclusion: Elevation of cTnI measured by an investigational high-sensitivity assay adds to clinical risk indicators for predicting long-term CV outcomes in patients with established SIHD. Pts with elevated S-TnI appeared to have a reduction in CVD or HF with intensive statin therapy.
- © 2012 by American Heart Association, Inc.