Stable chest pain syndromes: high-sensitivity troponin I shows biomarker promise

  • Januzzi JL & al.
  • J Am Coll Cardiol
  • 29 Jan 2019

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Among patients with stable chest pain but without known coronary artery disease (CAD), high-sensitivity troponin I (hsTnI) may flag those at risk for near-term major cardiovascular events.
  • Authors: “Identifying a single cutoff that provides stand-alone utility could be challenging.”
  • Editorial discusses troponin potential as biomarker for developing CAD, treatment monitoring.

Why this matters

  • It can be difficult to stratify risk in patients with stable CAD presentations.

Key results

  • hsTnI median concentrations among those who did (n=74) vs did not meet outcome: 2.1 vs 1.6 ng/L; P<.001.>
  • Risk rose in stepwise fashion, 0.8%-3.1%, with increasing hsTnI quartiles.
  • On multivariate analysis, per increase in log hsTnI interquartile range: HR, 1.54 (95% CI, 1.33-1.78; P<.001>
  • Predictive value was strongest in first 30 days; among patients who were event-free at 90 days, hsTnI no longer significantly predictive.

Study design

  • Analysis of prospective multicenter PROMISE trial, in which 4021 stable symptomatic outpatients without CAD diagnosis were randomly assigned to functional testing vs coronary CT angiography.
  • Participants stratified by baseline hsTnI.
  • Outcome: death, acute myocardial infarction, or hospitalization for unstable angina by 1 year. 
  • Funding: NIH; Singulex, Inc.

Limitations

  • Unclear how to interpret individual results.
  • Results might not apply to other troponin tests.

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