Single-Molecule Counting of High-Sensitivity Troponin I in Patients Referred for Diagnostic Angiography: Results From the CASABLANCA (Catheter Sampled Blood Archive in Cardiovascular Diseases) Study

Cian P McCarthy, Nasrien E Ibrahim, Asya Lyass, Yiwei Li, Hanna K Gaggin, Mandy L Simon, Renata Mukai, Parul Gandhi, Noreen Kelly, Shweta R Motiwala, Roland R J van Kimmenade, Joseph M Massaro, Ralph B D'Agostino Sr, James L Januzzi Jr, Cian P McCarthy, Nasrien E Ibrahim, Asya Lyass, Yiwei Li, Hanna K Gaggin, Mandy L Simon, Renata Mukai, Parul Gandhi, Noreen Kelly, Shweta R Motiwala, Roland R J van Kimmenade, Joseph M Massaro, Ralph B D'Agostino Sr, James L Januzzi Jr

Abstract

Background: The meaning of high-sensitivity troponin I (hsTnI) concentrations in patients without acute myocardial infarction (MI) requires clarity. We hypothesized that among patients referred for diagnostic coronary angiography without acute MI, hsTnI concentrations would correlate with prevalent coronary artery disease (CAD) and predict incident cardiovascular events and mortality.

Methods and results: We measured hsTnI using a single-molecule counting assay (99th percentile, 6 ng/L) in samples from 991 patients obtained at the time of angiography. Concentrations of hsTnI were assessed relative to the severity of CAD and prognosis during mean follow-up of 3.7 years. Median hsTnI concentration was 4.19 ng/L; 38% of patients had hsTnI concentrations ≥99th percentile. Across increasing hsTnI quartiles, patients had higher prevalence of angiographic CAD; in multivariate models, hsTnI ≥99th percentile independently predicted obstructive CAD (odds ratio: 2.57; P<0.001) and incident MI (hazard ratio [HR]: 2.68; P<0.001), cardiovascular death (HR: 2.29; P=0.001), and all-cause death (HR: 1.84; P=0.004). In those with >70% coronary stenosis, hsTnI ≥99th percentile independently predicted incident MI (HR: 1.87; P=0.01), cardiovascular mortality (HR: 2.74; P=0.001), and the composite end point of MI and all-cause death (HR: 2.06; P<0.001). In participants with coronary stenosis <70%, hsTnI ≥99th percentile even more strongly predicted incident MI (HR: 8.41; P<0.001), cardiovascular mortality (HR: 3.60; P=0.03), and the composite end point of MI and all-cause death (HR: 3.62; P<0.001).

Conclusions: In a large prospective cohort of patients who were free of prevalent MI and undergoing diagnostic coronary angiography, hsTnI concentrations were associated with higher prevalence of CAD and predicted incident MI, cardiovascular death, and all-cause death.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00842868.

Keywords: biomarkers; coronary artery disease; high‐sensitivity; troponin.

© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Study flow. Following removal of those without coronary angiography and those with prevalent myocardial infarction, the study sample comprised 991 patients. Angio indicates angiography; CASABLANCA, Catheter Sampled Blood Archive in Cardiovascular Diseases Study; MI, myocardial infarction.
Figure 2
Figure 2
Cumulative event curves over a follow‐up period of 1440 days in patients with or without elevated hsTnI ≥6 ng/L for (A) incident MI, (B) incident cardiovascular death, (C) all‐cause death, (D) composite of MI and all‐cause death, and (E) composite of MI and cardiovascular death. hsTnI indicates high‐sensitivity cardiac troponin I; MI, myocardial infarction.

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Source: PubMed

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