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