High-sensitivity cardiac troponin for risk prediction in stable patients with and without cardiac disease

Background: High-sensitivity troponin T (hsTnT) can improve risk prediction in stable patients. However, it is unknown if this is due to the detection of underlying cardiac diseases that are not diagnosed so far or if this prognostic value is independent of overt cardiac disease. The aim of the present analysis was to evaluate the use of hsTnT for risk prediction in subjects with or without cardiac disease. Methods: Stable patients with full cardiac assessment including ECG, echocardiography and elective coronary angiography were enrolled (n=2046). HsTnT and risk scores for adjustment (Framingham Risk Score and the SCORE) were determined before diagnostic procedures. Patients were followed for up to seven years. Primary endpoint was all-cause mortality or non-fatal myocardial infarction. All endpoints were adjudicated by independent physicians. Results: Out of the 2046 subjects enrolled, 1406 (69%) had significant heart disease defined diagnosis of obstructive coronary heart disease during index angiography and/or reduced left ventricular ejection fraction. The use of hsTnT in addition to clinical risk scores significantly improved the reclassification of the primary endpoint (Framingham: NRI=0.631, P<0.001; SCORE: NRI=0.656, P<0.001). Discrimination of risk scores for the primary endpoint did not show any significant differences between subjects with and without significant heart disease (Framingham: c-statistic=0.612 vs. 0.628, P=0.68; SCORE: c-statistic=0.593 vs. 0.650, P=0.10). ![Figure][1] Conclusion: The use of hsTnT can significantly improve discrimination and reclassification of stable patients irrespectively of the presence of cardiovascular disease. [1]: pending:yes