Prognostic Value of High-Sensitivity Cardiac Troponin T Compared with Risk Scores in Stable Cardiovascular Disease

Biener, Moritz; Giannitsis, Evangelos; Kuhner, Manuel; Zelniker, Thomas A; Mueller‐Hennessen, Matthias; Vafaie, Mehrshad; Trenk, Dietmar; Neumann, Franz‐Josef; Hochholzer, Willibald; Katus, Hugo A.

doi:10.1016/j.amjmed.2016.11.028

Cited by 12 publications

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“… 21 In another recently published analysis, we reported on the performance of hs-cTnT compared with established multivariable scores that are used in some European regions (Prospective Cardiovascular Münster Study (PROCAM) Score) or in the US (Framingham Scores) in primary prevention. 33 In consistency with the both previous studies, hs-cTnT predicted ACM with an AUC of 0.878 and thus—as expected—significantly better than the ESC-SCORE in secondary prevention. To our surprise, hs-cTnT also performed significantly better in non-secondary prevention, which is the domain of CV risk scores including the ESC-SCORE.…”

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confidence: 90%

Risk prediction in stable cardiovascular disease using a high-sensitivity cardiac troponin T single biomarker strategy compared to the ESC-SCORE

et al. 2018

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ObjectiveTo evaluate the prognostic performance of high-sensitivity cardiac troponin T (hs-cTnT) compared with the ESC-SCORE.MethodsWe included low-risk outpatients with stable cardiovascular (CV) disease categorised into need for non-secondary and secondary prevention. The prognostication of hs-cTnT at index visit was compared with the European Society of Cardiology-Systematic COronary Risk Evaluation (ESC-SCORE) with respect to all-cause mortality (ACM) and two composite endpoints (ACM, acute myocardial infarction (AMI) and stroke and ACM, AMI, stroke and rehospitalisation for acute coronary syndrome (ACS) and decompensated heart failure (DHF)).ResultsWithin a median follow-up of 796 days, a total of 16 deaths, 32 composite endpoints of ACM, AMI and stroke and 83 composite endpoints of ACM, AMI, stroke, rehospitalisation for ACS and DHF were observed among 693 stable low-risk outpatients. Using C-statistics, measurement of hs-cTnT alone outperformed the ESC-SCORE for the prediction of ACM in the entire study population (Δarea under the curve (AUC) 0.221, p=0.0039) and both prevention groups (non-secondary: ΔAUC 0.164, p=0.0208; secondary: ΔAUC 0.264, p=0.0134). For the prediction of all other secondary endpoints, hs-cTnT was at least as effective as the ESC-SCORE, both in secondary and non-secondary prevention. Using continuous and categorical net reclassification improvement and integrated discrimination improvement, hs-cTnT significantly improved reclassification regarding all endpoints in the entire population and in the secondary prevention cohort. In non-secondary prevention, hs-cTnT improved reclassification only for ACM. The results were confirmed in an independent external cohort on 2046 patients.ConclusionsHs-cTnT is superior to the multivariable ESC-SCORE for the prediction of ACM and a composite endpoint in stable outpatients with and without relevant CV disease.Trial registration numberNCT01954303; Pre-results.

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confidence: 90%

Risk prediction in stable cardiovascular disease using a high-sensitivity cardiac troponin T single biomarker strategy compared to the ESC-SCORE

et al. 2018

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“…Unfortunately, these clinical scores are inconvenient to use and suffer from poor adoption in clinical routine. There is accumulating evidence that measurement of cardiovascular biomarkers, that is, cTn, could improve risk stratification independent of and in addition to clinical scores in stable outpatients with or without CV disease 65. However, ESC guidelines on prevention62 discourage measurement of any circulating or urinary biomarker for refinement of cardiovascular risk stratification, at present.…”

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confidence: 99%

Troponins: established and novel indications in the management of cardiovascular disease

Giannitsis

Katus

2018

Heart

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With interest we read the comment from Safiri and Ayubi on our recent publication in The American Journal of Medicine. 1 We disagree that bootstrapping is a statistical method that should be preferred for validation. This comment gives us the opportunity to underscore the high relevance of our study that used external validation in a large independent cohort instead of bootstrapping that represents one of several internal validation strategies.

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Biener

Giannitsis

Katus

2017

The American Journal of Medicine

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Prognostic Value of High-Sensitivity Cardiac Troponin T Compared with Risk Scores in Stable Cardiovascular Disease

Cited by 12 publications

References 42 publications

Risk prediction in stable cardiovascular disease using a high-sensitivity cardiac troponin T single biomarker strategy compared to the ESC-SCORE

Risk prediction in stable cardiovascular disease using a high-sensitivity cardiac troponin T single biomarker strategy compared to the ESC-SCORE

Troponins: established and novel indications in the management of cardiovascular disease

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