Abstract
Background: Elevated levels of troponin are associated with future major adverse cardiac events (MACE). Data on the prognostic value of high sensitive troponin T (hs-TnT) compared to high sensitive troponin I (hs-TnI) in diabetic and non-diabetic patients are sparse.Methods: We analyzed patients of a single-center registry undergoing coronary stenting between 2003 and 2006. As a primary endpoint we assessed MACE, a composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke according to sex and diabetes status using log-rank. As a second endpoint, we assessed the prognostic impact of hs-TnT and hs-TnI on MACE, adjusting for known confounders using Cox regression analysis.Results: Out of 818 investigated patients, 267 (32.6%) were female. Diabetes mellitus type 2 (T2DM) was diagnosed in 206 (25.2%) patients.After a mean follow-up of 6.6 ± 3.7 years, MACE occurred in 235 (28.7%) patients. The primary endpoint components of cardiovascular death occurred in 115 (14.1%) patients, MI in 75 (9.2%), and ischemic stroke in 45 (5.5%). Outcomes differed significantly according to sex and diabetes status (p = 0.003). In descending order, MACE rates were as follows: female diabetic patients (40.8%), female non-diabetic patients (32.7%), male diabetic patients (28.9%), and male non-diabetic patients (24.8%). Additionally, females with diabetes were at higher risk of cardiovascular death compared to diabetic men (28 vs. 15%). Hs-TnI (HR 1.477 [95% CI 1.100–1.985]; p = 0.010) and hs-TnT (HR 1.615 [95%CI 1.111–2.348]; p = 0.012) above the 99th percentile were significantly associated with MACE. Both assays showed tendency toward association with MACE in all subgroups.Conclusion: Diabetic patients, particularly females, with known coronary artery disease had a higher risk of subsequent MACE. Both, hs-TnI and hs-TnT significantly correlated with MACE.
Highlights
Diabetes has been shown to be a major risk factor for adverse outcomes in patients with and without known coronary artery disease (CAD) [1,2,3]
Hs-TnI (HR 1.477 [95% CI 1.100–1.985]; p = 0.010) and hs-Troponin T (TnT) (HR 1.615 [95%CI 1.111–2.348]; p = 0.012) above the 99th percentile were significantly associated with major adverse cardiovascular events (MACE)
Diabetic patients, females, with known coronary artery disease had a higher risk of subsequent MACE
Summary
Diabetes has been shown to be a major risk factor for adverse outcomes in patients with and without known coronary artery disease (CAD) [1,2,3]. Adjacent to the clinical importance of troponin in the diagnosis of ACS, cardiac troponin is significantly related to subsequent major adverse cardiovascular events (MACE) [9,10,11,12,13]. Similar findings have been shown for patients with stable CAD (SCAD), in which elevated levels of troponin were related to long-term MACE, the mechanism of chronic troponin elevation in SCAD is still matter of debate [14]. Chronic troponin elevations in SCAD patients are related to atherosclerotic plaque burden detected by CT scan and may reflect ongoing silent myocardial injury [15]. Elevated levels of troponin are associated with future major adverse cardiac events (MACE). Data on the prognostic value of high sensitive troponin T (hs-TnT) compared to high sensitive troponin I (hs-TnI) in diabetic and non-diabetic patients are sparse
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