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

Abstract

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.

High-Sensitivity Troponin T vs I in Acute Coronary Syndrome: Prediction of Significant Coronary Lesions and Long-term Prognosis

“…When comparing hs-cTnT to a risk score developed by the European Society of Cardiology (ESC), elevated troponin levels were superior in predicting an adverse outcome. 155 More advanced testing could identify more patients at risk in this group but will require more resources and thus increase the strain on the health-care system.…”

Elevated High-Sensitivity Troponin I in the Stabilized Phase after na Acute Coronary Syndrome Predicts All-Cause and Cardiovascular Mortality in a Highly Admixed Population: A 7-Year Cohort

“…Outside the scope of ACS, several studies have also found an association between elevated cTn levels and risk of death. In patients with stable coronary heart disease, a greater risk for cardiovascular mortality and incidence of heart failure has been found in those with higher levels of hs-cTnT 26 - 28 and hs-cTnI. 29 Elevated circulating hs-cTnT was also shown to be independently associated with higher mortality in outpatients with stable heart failure, 30 , 31 and in patients with aortic stenosis.…”

Biomarkers of Uremic Cardiotoxicity

“…Also, so-called uremic cardiomyopathy may contribute to the level of troponin by different mechanisms, including uremia-induced structural changes in the myocardium, endothelial dysfunction, loss of membrane integrity, and ’leaking’ of troponin from cardiomyocytes. Certain studies suggest that troponin is a more prognostic than diagnostic biomarker [ 48 ]. In the present study, the patients with registered CV events had higher values of troponin, but its predictive power was not confirmed by Cox regression analysis.…”