Clinical significance of undetectable high sensitivity cardiac troponin I (hs-TnI) in Thai individuals with low cardiovascular risk

Abstract

Abstract Introduction The long term prognosis of individuals who has undetectable hs-TnI is poorly defined in low cardiovascular risk. We aim to examine whether undetectable hs-TnI individuals have better cardiovascular outcomes in low cardiovascular risk population. Methods Data of low cardiovascular risk population (<7.5%) who has no established of atherosclerosis cardiovascular disease (ASCVD) was derived from the Electricity Generating Authority of Thailand (EGAT) study in 2007–2009 survey. High sensitivity cardiac troponin I was measured by using the Abbott ARCHITECT i2000 SR assay. We categorized level of hs-TnI into undetectable hs-TnI (<1.9 ng/L), low hs-TnI, intermediate and more hsTnI by gendered specific cut-off. The low cardiovascular risk population was classified into extremely low risk (<5%) and low risk (5–7.5%). Major cardiovascular event (MACE) and all-cause mortality were collected until 31st December 2019. Survival analysis and subgroup analysis were performed. Results A total of 3,442 participants were eligible. Mean age was 43.6 years-old, 65.5% male, hs-TnI was detected 79.8%, median hs-cTnI was 2.6 ng/L (2,3.6). During median time followed-up 10.3 years, 52 events (1.5%) of MACE and 60 events (1.7%) of all-cause mortality occurred. After adjusted for conventional risk factors, hs-cTnI significantly associated with incidence of MACE (HR 1.03 95% CI 1.02–1.04, p-value <0.001). Compared with intermediate and more hs-TnI group, undetectable hs-TnI and low hs-TnI had 79% and 52% lower incidence of MACE (HR 0.21, 95% CI (0.05–0.79) and HR 0.48, 95% CI (0.23–1.0), p-value for trend 0.04. Subgroup analysis, incidence of MACE remained higher either extremely low or low CV risk compared with those undetectable hs-TnI. (P for interact 0.83) Conclusion Among individuals with low cardiovascular risk, hs-TnI testing can provide risk prognostication. Undetectable hs-TnI could be as a negative risk marker for adverse cardiovascular events. Funding Acknowledgement Type of funding sources: None.