Abstract
BackgroundRecent studies have demonstrated the association between increased concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and the incidence of myocardial infarction, heart failure, and mortality. However, most prognostic studies to date focus on the value of hs-cTnT in the elderly or general population. The value of hs-cTnT in symptomatic patients visiting the outpatient department remains unclear. The aim of this study was to investigate the prognostic value of hs-cTnT as a biomarker in patients with symptoms of chest discomfort suspected for coronary artery disease and to assess its additional value in combination with other risk stratification tools in predicting cardiac events.MethodsWe studied 1,088 patients (follow-up 2.2±0.8 years) with chest discomfort who underwent coronary calcium scoring and coronary CT-angiography. Traditional cardiovascular risk factors and concentrations of hs-cTnT, N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP) were assessed. Study endpoint was the occurrence of late coronary revascularization (>90 days), acute coronary syndrome, and cardiac mortality.ResultsHs-cTnT was a significant predictor for the composite endpoint (highest quartile [Q4]>6.7 ng/L, HR 3.55; 95%CI 1.88–6.70; P<0.001). Survival analysis showed that hs-cTnT had significant predictive value on top of current risk stratification tools (Chi-square change P<0.01). In patients with hs-cTnT in Q4 versus <Q4, a 2- to 3-fold increase in cardiovascular risk was noticed, either when corrected for high or low Framingham risk score, coronary calcium scoring, or CT-angiography assessment (HR 3.11; 2.73; 2.47; respectively; all P<0.01). This was not the case for hsCRP and NT-proBNP.ConclusionsHs-cTnT is a useful prognostic biomarker in patients with chest discomfort suspected for coronary artery disease. In addition, hs-cTnT was an independent predictor for cardiac events when corrected for cardiovascular risk profiling, calcium score and CT-angiography results.
Highlights
Identification of patients at risk for acute cardiovascular events remains a challenge
Study population We studied 1,114 patients with symptoms of chest discomfort who were referred from the cardiology outpatient department for coronary computed tomographic angiography (CCTA) because of suspected coronary artery disease (CAD), according to the appropriateness criteria for cardiac computed tomography [14]
As a result of CCTA, 50 patients underwent revascularization within 90 days (356 percutaneous coronary intervention (PCI), 156CABG) and these were censored at the time of revascularization
Summary
Identification of patients at risk for acute cardiovascular events remains a challenge. Elevated concentrations of N-terminal pro-B-type natriuretic peptide (NTproBNP), the inactive fragment from BNP which is secreted by the cardiomyocytes in response to ventricular wall stretch, have been associated with an increased risk of death and cardiovascular events [4]. None of these biomarkers have achieved widespread acceptance in daily practise as a risk stratification tool for the detection of coronary artery disease (CAD). The aim of this study was to investigate the prognostic value of hs-cTnT as a biomarker in patients with symptoms of chest discomfort suspected for coronary artery disease and to assess its additional value in combination with other risk stratification tools in predicting cardiac events
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