Abstract 15947: Cracking the Code of Cardiovascular Risk: Cardiac Troponin I vs. T in Community Dwelling Adults. Is Specificity at Stake?

Abstract

Introduction. High sensitive cardiac troponin I and T (hs-cTnI and T) are detectable in most adults. Several studies have identified that hs-cTnI and T perform differently for long-term prediction of incident myocardial infarction (MI). Furthermore, in adults with myopathies, hs-cTnT can lose cardiovascular (CV) specificity which may be more relevant to MI prediction vs heart failure (HF) and CV death (CVD). We hypothesized that a meta-analysis of ambulatory adult studies would demonstrate hs-cTnI is a superior predictor of incident MI, but similar for HF and CVD. Methods. Research articles on hs-cTnI or T for longitudinal outcomes in ambulatory adults were screened from PubMed, EMBASE, and Web of Science inclusive of incident MI, HF or CVD and reporting hazard ratios (HR) and 95% confidence intervals (CI) for hs-cTn on a continuous log scale. Two reviewers evaluated the studies for inclusion, removing overlapping populations and extracting the most adjusted model HR. Pooled effect sizes were calculated with a random-effects model, and heterogeneity was assessed using the I 2 statistic. Subgroup analyses based on hs-cTn type were conducted. Results. A total of 3092 studies were screened and 44 met inclusion criteria. There were 109,553, 80,597, and 141,389 participants for HF, MI, and CVD with hs-cTnI measured, and 90,012, 81,259, and 73,977 participants for HF, MI, and CVD with hs-cTnT measured with a mean age of 61 ± 10 years and a median follow-up of 2.1 – 20 years. The pooled effect size estimate (HR) for HF, MI and CVD was 1.57(1.47, 1.66), 1.27(1.18, 1.37) and 1.41(1.32, 1.50) respectively. Subgroup analyses showed similar HR values for HF (I: 1.49 (1.37, 1.62) and T: 1.64 (1.51, 1.78)), MI (Figure) and CVD (I: 1.32 (1.21, 1.44) and T: 1.49 (1.36, 1.63)). Conclusion. hs-cTnI and T are prognostically similar for incident MI, as well as HF and CVD in ambulatory adults, suggesting similar cardiac specificity, though substantial heterogeneity exists between individual studies.