A Sensitive Cardiac Troponin T Assay in Stable Coronary Artery Disease

Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
New England Journal of Medicine (Impact Factor: 55.87). 11/2009; 361(26):2538-47. DOI: 10.1056/NEJMoa0805299
Source: PubMed


In most patients with stable coronary artery disease, plasma cardiac troponin T levels are below the limit of detection for the conventional assay. The distribution and determinants of very low circulating troponin T levels, as well as their association with cardiovascular events, in such patients are unknown.
We used a new, high-sensitivity assay to determine the concentration of cardiac troponin T in plasma samples from 3679 patients with stable coronary artery disease and preserved left ventricular function. Results of the assay were analyzed in relation to the incidence of cardiovascular events during a median follow-up period of 5.2 years.
With the highly sensitive assay, concentrations of cardiac troponin T were at or above the limit of detection (0.001 microg per liter) in 3593 patients (97.7%) and at or above the 99th percentile for apparently healthy subjects (0.0133 microg per liter) in 407 patients (11.1%). After adjustment for other independent prognostic indicators, there was a strong and graded increase in the cumulative incidence of cardiovascular death (adjusted hazard ratio per unit increase in the natural logarithm of the troponin T level, 2.09; 95% confidence interval [CI], 1.60 to 2.74; P<0.001) and of heart failure (adjusted hazard ratio, 2.20; 95% CI, 1.66 to 2.90; P<0.001) in this study group. Increased risk associated with higher levels of troponin T was evident well below the limit of detection of conventional cardiac troponin T assays and below the 99th percentile of values in a healthy population. There was no association between troponin T levels as measured with the highly sensitive assay and the incidence of myocardial infarction (adjusted hazard ratio, 1.16; 95% CI, 0.97 to 1.40; P=0.11).
After adjustment for other independent prognostic indicators, cardiac troponin T concentrations as measured with a highly sensitive assay were significantly associated with the incidence of cardiovascular death and heart failure but not with myocardial infarction in patients with stable coronary artery disease.

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    • "2. Additional studies assessing outcome-based cutoffs for the hs-cTn assays for both diagnosis and prognosis. Research in patients with stable coronary artery disease has suggested utility in risk stratification [10] [11] [12] [13]; however, data is needed in the acute care setting in various hospitalized patient groups at risk for myocardial injury [1, 14–18]. Specifically, outcome-based cutoffs (either alone or in combination with clinical variables) that accurately identify emergency department patients with symptoms of possible ACS who are at short-term risk of adverse cardiac events are essential for the appropriate identification of emergency department patients in need of admission for invasive coronary investigations. "

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