1 Clinical Microbiology, Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU2 unknown3 SUND ph.d. skole4 Kirurgi og Intern Medicin5 2012 Institut for Farmakologi og Farmakoterapi6 Institut for Klinisk Medicin7 National Institute of Public Health, Det Sundhedsvidenskabelige Fakultet, SDU8 Biostatistisk afdeling9 Clinical Microbiology, Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU10 National Institute of Public Health, Det Sundhedsvidenskabelige Fakultet, SDU
AIMS: Low prevalence of detectable cardiac troponin in healthy people and low-risk patients previously curtailed its use. With a new high-sensitive cardiac troponin assay (hs-cTnT), concentrations below conventional detection may have prognostic value, notably in combination with N-terminal pro-B-type natriuretic peptide (NT-pro-BNP). METHODS AND RESULTS: Biomarker concentrations were determined from serum obtained at enrolment in the CLARICOR trial involving 4197 patients with stable coronary artery disease (CAD) followed for 2.6 years. Serum hs-cTnT was detectable (above 3 ng/l) in 78% and above the conventional 99th percentile (13.5 ng/l) in 23%. Across all levels of hs-cTnT there was a graded increase in the risk of cardiovascular death after adjustment for known prognostic indicators: hazard ratio (HR) per unit increase in the natural logarithm of the hs-cTnT level, 1.49; 95% confidence interval (CI), 1.23-1.81; similarly for all-cause mortality (HR 1.48, 95% CI 1.29-1.70) and myocardial infarction (HR 1.37, 95% CI 1.13-1.67). Increasing values of hs-cTnT were associated with increased mortality across all values of NT-pro-BNP, but this was particularly prominent when NT-pro-BNP >400 ng/l. CONCLUSIONS: In patients with stable CAD, any detectable hs-cTnT level is significantly associated with all-cause mortality, cardiovascular death, and myocardial infarction after adjustment for traditional risk factors and NT-pro-BNP. Excess mortality is particularly pronounced in patients with NT-pro-BNP >400 ng/l.
European Journal of Preventive Cardiology, 2014, Vol 21, Issue 10, p. 1275-84
Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't