Predicting myocardial infarction and other serious cardiac outcomes using high-sensitivity cardiac troponin T in a high-risk stable population
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OBJECTIVES: Previous work on high-sensitivity troponin I (hs-cTnI) has demonstrated that it may identify patients with stable cardiovascular disease (CVD) at risk for future myocardial infarction (MI). In this study, we assessed if hs-cTnT concentrations could also identify those stable CVD patients at high risk for future MI and other ischemic cardiac outcomes. METHODS: hs-cTnT (lot:153-401) was measured in specimens obtained at randomisation in the Heart Outcomes Prevention Evaluation (HOPE) study (n=2941 stable CVD patients, 4.5 years follow-up). The primary outcome for the HOPE study (MI, stroke, or cardiovascular death) was used to identify cutoffs by receiver operating characteristic (ROC) curve analysis and was used in conjunction with the 95th and 99th percentile upper limits to construct different concentration ranges, which were assessed using log-rank tests and multivariable Cox proportional hazard models. These different concentration ranges were then assessed for the components of the primary outcome and for heart failure (HF). RESULTS: The ROC derived hs-cTnT cutoff was 8 ng/L for the primary outcome. Subjects with hs-cTnT either below (8 to <14 ng/L) or slightly above the published 99th from a healthy population (14 to 21 ng/L) had similar probability for the primary outcome. Those with hs-cTnT concentrations >31 ng/L had the highest probability and greatest risk for future MI, HF, and cardiovascular death as compared to those with hs-cTnT concentrations <8 ng/L. CONCLUSION: In patients with stable CVD disease hs-cTnT measurement identifies those at risk for MI as well as HF and cardiovascular death.
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