The Prognostic Value of High-Sensitive Troponin I in Stable Coronary Artery Disease Depends on Age and Other Clinical Variables

Abstract

Objectives: To study the prognostic value of high-sensitive troponin (hs-cTn) I in stable coronary artery disease. Methods: In total, we studied 705 patients. Secondary outcomes were the incidence of: (1) acute ischemic events and (2) heart failure or death. The primary outcome was the composite of them. Results: Patients with hs-cTnI >0 ng/ml (62.1%) were older, had a lower estimated glomerular filtration rate, more frequent a history of hypertension, atrial fibrillation, ejection fraction <40%, and therapy with angiotensin-converting enzyme inhibitors, diuretics and acenocumarol. The follow-up period was 2.2 ± 0.99 years. Fifty-three patients suffered an acute ischemic event, 33 died or suffered heart failure and 78 developed the primary outcome. By univariate Cox's regression analysis, hs-cTnI >0 was associated with a higher risk of developing the primary outcome [relative risk = 2.360 (1.359-4.099); p = 0.001] and heart failure or death [relative risk = 5.932 (1.806-19.482); p < 0.001], but not with acute ischemic events. Statistical significance was lost after controlling for age. By logistic regression analysis, age [relative risk = 1.026 (1.009-1.044); p = 0.003], ejection fraction <40% [relative risk = 4.099 (2.043-8.224); p < 0.001], use of anticoagulants [relative risk = 2.785 (1.049-7.395); p = 0.040] and therapy with angiotensin-converting enzyme inhibitors [relative risk = 1.471 (1.064-2.034); p = 0.020], and estimated glomerular filtration rate [relative risk = 0.988 (0.977-0.999); p = 0.027] were associated with hs-cTnI >0. Conclusions: In stable coronary disease, hs-cTnI is associated with the incidence of heart failure or death, but this relationship depends on other variables.

Elevated plasma levels of cardiac troponin-I predict left ventricular systolic dysfunction in patients with myotonic dystrophy type 1: A multicentre cohort follow-up study

“…However, high-sensitivity cardiac troponin assays have also shown promise as prognostic biomarkers of cardiovascular risk in a variety of ambulatory outpatient settings, including among those with known vascular disease,[28, 29] the elderly [30, 31] and in general population-based studies. [27, 32–35] The cause of chronic, low-level troponin elevation in these populations is uncertain, although speculated mechanisms include subclinical ischaemia, microvascular dysfunction or apoptosis of myocytes.…”

25‐Hydroxyvitamin D Levels and Markers of Subclinical Myocardial Damage and Wall Stress: The Atherosclerosis Risk in Communities Study

“…It may be that in older patients, who already have a higher prevalence of structural cardiac abnormalities (ie, stage B HF) and subclinical atherosclerosis, the role of vitamin D relative to other traditional risk factors is less impactful. Elevated hs‐cTnT is more common in older adults because of a higher prevalence of nonacute coronary syndrome conditions like structural heart disease . A level of 14 ng/L is also a much more extreme elevation by percentile of population in a younger person than in an older person.…”

“…Of note, for patients with acute coronary syndromes, a prior study found that the relative prognostic significance of an elevated troponin level attenuates with age, such that an elevated troponin value confers a higher relative risk among younger compared with older adults . Furthermore, the diagnostic performance of hs‐cTnT for acute coronary syndromes is superior in younger versus older adults …”

“…19 Furthermore, the diagnostic performance of hs-cTnT for acute coronary syndromes is superior in younger versus older adults. 33 When considering change in hs-cTnT over 6 years on a continuous level, higher (compared with lower) vitamin D levels were associated with less increase in hs-cTnT levels over time after adjustment of CVD risk factors. This association was statistically significant only in women, although qualitatively, the results were similar in men with no significant interaction by sex.…”

“…Elevated hs-cTnT is more common in older adults because of a higher prevalence of nonacute coronary syndrome conditions like structural heart disease. 33 A level of 14 ng/L is also a much more extreme elevation by percentile of population in a younger person than in an older person. Of note, for patients with acute coronary syndromes, a prior study found that the relative prognostic significance of an elevated troponin level attenuates with age, such that an elevated troponin value confers a higher relative risk among younger compared with older adults.…”