Abstract 12675: High Sensitivity Cardiac Troponin T and B-Type Natriuretic Peptide Predict Death and Major Cardiovascular Events but Not Benefit From Immediate Revascularization in Type 2 Diabetes and Stable Ischemic Heart Disease: A BARI 2D Substudy
Background:High-sensitivity cardiac troponin T (hsTnT) and B-type natriuretic peptide (NT-proBNP) are strongly associated with death and major cardiovascular (CV) events and in acute coronary syndromes identify patients who benefit from revascularization. Whether coronary revascularization mitigates risk in patients with stable ischemic heart disease (SIHD) and abnormal hsTnT or NT-proBNP is unknown.
Methods and Results:We measured hsTnT and NT-proBNP in 2285 patients from the BARI-2D trial (NCT00006305), a randomized trial of prompt revascularization vs. intensive medical therapy for the prevention of death, or the composite of death/MI/stroke in patients with type 2 diabetes (T2D) and SIHD. At baseline, 2277 (99.6%) had a detectable (≥ 3 ng/L) hsTnT. Thirty nine percent (893/2285) of patients had hsTnT concentrations ≥14 ng/L, the manufacturer’s upper reference limit. For these patients the 5-year mortality rate was 19.6%, vs. 7.1% for those with hsTnT<14 ng/L (Figure). For patients in the highest tertile of NT-proBNP (≥243 ng/L) the 5-year mortality rate was 20.6%, vs. 11.1% in the middle and 5.7% in the lowest tertiles. (Figure). In adjusted models, the relative risk (95% CI) of death/MI/stroke was 1.7 (1.4-2.1) for hsTnT ≥14 vs. hsTnT<14 ng/L and 1.8 (1.4-2.3) for highest vs. lowest tertiles of NT-proBNP. For patients with hsTnT≥14 ng/L, random allocation to prompt revascularization compared with medical therapy did not appear to prevent death [HR 1.06 (0.8-1.4)] or death/MI/stroke [HR 0.88 (0.7-1.1)]. In patients in the highest tertile of NT-proBNP, prompt revascularization did not alter the risk of death [HR 1.2, (0.9-1.6)] or death/MI/stroke [HR 1.0 (0.8-1.3)].
Conclusions:Evidence of ongoing myocardial injury as measured by high-sensitivity troponin T, and myocardial stress, as measured by circulating NT-proBNP, predict death and death/MI/stroke but do not predict benefit from prompt revascularization is patients with T2D and SIHD.
- Coronary artery disease
- Percutaneous coronary intervention (PCI)
- Coronary artery bypass grafting (CABG)
- Diabetes (Type II)
Author Disclosures: B.M. Everett: Research Grant; Significant; Roche Diagnostics, Novartis Pharmaceuticals. Consultant/Advisory Board; Modest; SOCAR research. M. Brooks: Research Grant; Significant; GenWay Biotech, Inc. H. Vlachos: None. B. Chaitman: None. R. Frye: None. D. Bhatt: Research Grant; Significant; Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Roche, Sanofi Aventis, The Medicines Company.
- © 2014 by American Heart Association, Inc.