Abstract P302: Association of High-Sensitive Troponin I With Coronary Heart Disease Incidence Among Asymptomatic Older Adults: The ADVANCE Study
Background: The third generation of cardiac troponin-I assays (high-sensitive troponin-I, hs-TI) has a lower limit of detection one order of magnitude lower than current commercial assays. Elevated hs-TI has been associated with structural and coronary heart disease (CHD), but data remains sparse, particularly in asymptomatic subjects free of clinical cardiovascular disease (CVD).
Methods: Among asymptomatic subjects with no known CVD in The Atherosclerotic Disease, VAscular FunctioN and GenetiC Epidemiology (ADVANCE) Study recruited in 2002-04 (mean ± SD age=62 ± 8 years, 49% women; 52% non-white), we identified the correlates of hs-TI and the independent predictive value of hs-TI for incident CHD (hospitalization or death with ICD9 codes 410-414 or coronary revascularization procedures) over a median of 8 years of follow-up. Hs-TI was measured using stored serum with the Abbott ARCHITECT STAT assay, a chemiluminescent microparticle immunoassay (CMIA).
Results: There were 153 CHD events among 1,157 subjects. The median (interquartile range, in ng/L) of hs-TI was 4.1 (3.1-5.5) in men and 3.3 (2.5-4.2) in women. The independent (positive) correlates of hs-TI were black race, body mass index, diabetes and hypertension. Age-adjusted CHD rates showed a threshold effect at the 4th quartile. In proportional hazards regression, there was a 2.4-fold increased risk of CHD associated with the sex-specific quartile IV (relative to quartiles I-III combined) in Model 1 adjusting for age, gender and race/ethnicity. The increased risk was only partially explained by adjustment for Framingham risk score (FRS), C-reactive protein and estimated glomerular filtration rate (Model 2). The area under the curve (AUC) improved from 0.66 to 0.69 (p=0.05) after adding hs-TI to a model with Model 2 covariates, and the net reclassification improvement (NRI) was 0.13 (p=0.01).
Conclusion: Among asymptomatic adults without known CVD, hs-TI may be useful for helping identify patients at increased CHD risk beyond traditional risk factors.
Author Disclosures: C. Iribarren: B. Research Grant; Modest; Grant from Abbott Diagnostics. M. Chandra: None. J.S. Rana: None. M.A. Hlatky: None. S.P. Fortmann: None. T. Quertermous: None. A.S. Go: B. Research Grant; Significant; Grant from Genentech.
- © 2015 by American Heart Association, Inc.