Risk prediction in stable cardiovascular disease using a high-sensitivity cardiac troponin T single biomarker strategy compared to the ESC-SCORE

Moritz Biener, Evangelos Giannitsis, Manuel Kuhner, Thomas Zelniker, Matthias Mueller-Hennessen, Mehrshad Vafaie, Kiril M Stoyanov, Franz-Josef Neumann, Hugo A Katus, Willibald Hochholzer, Christian Marc Valina, Moritz Biener, Evangelos Giannitsis, Manuel Kuhner, Thomas Zelniker, Matthias Mueller-Hennessen, Mehrshad Vafaie, Kiril M Stoyanov, Franz-Josef Neumann, Hugo A Katus, Willibald Hochholzer, Christian Marc Valina

Abstract

Objective: To evaluate the prognostic performance of high-sensitivity cardiac troponin T (hs-cTnT) compared with the ESC-SCORE.

Methods: We included low-risk outpatients with stable cardiovascular (CV) disease categorised into need for non-secondary and secondary prevention. The prognostication of hs-cTnT at index visit was compared with the European Society of Cardiology-Systematic COronary Risk Evaluation (ESC-SCORE) with respect to all-cause mortality (ACM) and two composite endpoints (ACM, acute myocardial infarction (AMI) and stroke and ACM, AMI, stroke and rehospitalisation for acute coronary syndrome (ACS) and decompensated heart failure (DHF)).

Results: Within a median follow-up of 796 days, a total of 16 deaths, 32 composite endpoints of ACM, AMI and stroke and 83 composite endpoints of ACM, AMI, stroke, rehospitalisation for ACS and DHF were observed among 693 stable low-risk outpatients. Using C-statistics, measurement of hs-cTnT alone outperformed the ESC-SCORE for the prediction of ACM in the entire study population (Δarea under the curve (AUC) 0.221, p=0.0039) and both prevention groups (non-secondary: ΔAUC 0.164, p=0.0208; secondary: ΔAUC 0.264, p=0.0134). For the prediction of all other secondary endpoints, hs-cTnT was at least as effective as the ESC-SCORE, both in secondary and non-secondary prevention. Using continuous and categorical net reclassification improvement and integrated discrimination improvement, hs-cTnT significantly improved reclassification regarding all endpoints in the entire population and in the secondary prevention cohort. In non-secondary prevention, hs-cTnT improved reclassification only for ACM. The results were confirmed in an independent external cohort on 2046 patients.

Conclusions: Hs-cTnT is superior to the multivariable ESC-SCORE for the prediction of ACM and a composite endpoint in stable outpatients with and without relevant CV disease.

Trial registration number: NCT01954303; Pre-results.

Keywords: coronary artery disease; prevention; risk factors; score; troponin.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study population.
Figure 2
Figure 2
Prognostic performance of the ESC-SCORE for different outcomes in non-secondary and secondary prevention.
Figure 3
Figure 3
Prognostic performance of high-sensitivity cardiac troponin T (hs-cTnT) compared with the European Society of Cardiology-Systematic COronary Risk Evaluation (ESC-SCORE) in the prediction of all-cause mortality in non-secondary and secondary prevention.

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