Detectable high-sensitivity cardiac troponin within the population reference interval conveys high 5-year cardiovascular risk: An observational study

Martin P. Than, Sally J. Aldous, Richard W. Troughton, Christopher J. Pemberton, A. Mark Richards, Christopher M.A. Frampton, Christopher M. Florkowski, Peter M. George, Samantha Bailey, Joanna M. Young, Louise Cullen, Jaimi H. Greenslade, William A. Parsonage, Brendan M. Everett, W. Frank Peacock, Allan S Jaffe, John W. Pickering

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Increased cardiac troponin I or T detected by high-sensitivity assays (hs-cTnI or hs-cTnT) confers an increased risk of adverse prognosis. We determined whether patients presenting with putatively normal, detectable cTn concentrations [limit of detection and upper reference limit (URL)] have increased risk of major adverse cardiovascular events (MACE) or all-cause mortality. METHODS: A prospective 5-year follow-up of patients recruited in the emergency department with possible acute coronary syndrome (ACS) and cTn concentrations measured with hs-cTnI (Abbott) and hs-cTnT (Roche) assays. Cox regression models were generated with adjustment for covariates in those withoutMACEon presentation. Hazard ratios (HRs) for hs-cTn were calculated relative to the HRs at the median concentration. RESULTS: Of 1113 patients, 836 were without presentation MACE. Of these, 138 incurred a MACE and 169 died during a median 5.8-year follow-up. HRs for MACE at the URLs were 2.3 (95% CI, 1.7-3.2) for hs-cTnI and 1.8 (95% CI, 1.3-2.4) for hs-cTnT. Corresponding HRs for mortality were 1.7 (95% CI, 1.2-2.2) for hs-cTnI and 2.3 (95 % CI, 1.7-3.1) for hs-cTnT. The HR for MACE increased with increasing hs-cTn concentration similarly for both assays, but the HR for mortality increased at approximately twice the rate for hs-cTnT than hs-cTnI. Patients with hs-cTnI ≥10 ng/L or hs-cTnT ≥16 ng/L had the same percentage of MACE at 5-year follow-up (33%) as patients with presentation MACE. CONCLUSIONS: Many patients with ACS ruled out and putatively normal but detectable hs-cTnI concentrations are at similar long-term risk as those with MACE. hscTnT concentrations are more strongly associated with 5-year mortality than hs-cTnI.

Original languageEnglish (US)
Pages (from-to)1044-1053
Number of pages10
JournalClinical Chemistry
Volume64
Issue number7
DOIs
StatePublished - Jul 1 2018

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Troponin
Observational Studies
Hazards
Population
Assays
Mortality
Acute Coronary Syndrome
Troponin T
Troponin I
Proportional Hazards Models
Limit of Detection
Hospital Emergency Service
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ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Than, M. P., Aldous, S. J., Troughton, R. W., Pemberton, C. J., Richards, A. M., Frampton, C. M. A., ... Pickering, J. W. (2018). Detectable high-sensitivity cardiac troponin within the population reference interval conveys high 5-year cardiovascular risk: An observational study. Clinical Chemistry, 64(7), 1044-1053. https://doi.org/10.1373/clinchem.2017.285700

Detectable high-sensitivity cardiac troponin within the population reference interval conveys high 5-year cardiovascular risk : An observational study. / Than, Martin P.; Aldous, Sally J.; Troughton, Richard W.; Pemberton, Christopher J.; Richards, A. Mark; Frampton, Christopher M.A.; Florkowski, Christopher M.; George, Peter M.; Bailey, Samantha; Young, Joanna M.; Cullen, Louise; Greenslade, Jaimi H.; Parsonage, William A.; Everett, Brendan M.; Peacock, W. Frank; Jaffe, Allan S; Pickering, John W.

In: Clinical Chemistry, Vol. 64, No. 7, 01.07.2018, p. 1044-1053.

Research output: Contribution to journalArticle

Than, MP, Aldous, SJ, Troughton, RW, Pemberton, CJ, Richards, AM, Frampton, CMA, Florkowski, CM, George, PM, Bailey, S, Young, JM, Cullen, L, Greenslade, JH, Parsonage, WA, Everett, BM, Peacock, WF, Jaffe, AS & Pickering, JW 2018, 'Detectable high-sensitivity cardiac troponin within the population reference interval conveys high 5-year cardiovascular risk: An observational study', Clinical Chemistry, vol. 64, no. 7, pp. 1044-1053. https://doi.org/10.1373/clinchem.2017.285700
Than, Martin P. ; Aldous, Sally J. ; Troughton, Richard W. ; Pemberton, Christopher J. ; Richards, A. Mark ; Frampton, Christopher M.A. ; Florkowski, Christopher M. ; George, Peter M. ; Bailey, Samantha ; Young, Joanna M. ; Cullen, Louise ; Greenslade, Jaimi H. ; Parsonage, William A. ; Everett, Brendan M. ; Peacock, W. Frank ; Jaffe, Allan S ; Pickering, John W. / Detectable high-sensitivity cardiac troponin within the population reference interval conveys high 5-year cardiovascular risk : An observational study. In: Clinical Chemistry. 2018 ; Vol. 64, No. 7. pp. 1044-1053.
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abstract = "BACKGROUND: Increased cardiac troponin I or T detected by high-sensitivity assays (hs-cTnI or hs-cTnT) confers an increased risk of adverse prognosis. We determined whether patients presenting with putatively normal, detectable cTn concentrations [limit of detection and upper reference limit (URL)] have increased risk of major adverse cardiovascular events (MACE) or all-cause mortality. METHODS: A prospective 5-year follow-up of patients recruited in the emergency department with possible acute coronary syndrome (ACS) and cTn concentrations measured with hs-cTnI (Abbott) and hs-cTnT (Roche) assays. Cox regression models were generated with adjustment for covariates in those withoutMACEon presentation. Hazard ratios (HRs) for hs-cTn were calculated relative to the HRs at the median concentration. RESULTS: Of 1113 patients, 836 were without presentation MACE. Of these, 138 incurred a MACE and 169 died during a median 5.8-year follow-up. HRs for MACE at the URLs were 2.3 (95{\%} CI, 1.7-3.2) for hs-cTnI and 1.8 (95{\%} CI, 1.3-2.4) for hs-cTnT. Corresponding HRs for mortality were 1.7 (95{\%} CI, 1.2-2.2) for hs-cTnI and 2.3 (95 {\%} CI, 1.7-3.1) for hs-cTnT. The HR for MACE increased with increasing hs-cTn concentration similarly for both assays, but the HR for mortality increased at approximately twice the rate for hs-cTnT than hs-cTnI. Patients with hs-cTnI ≥10 ng/L or hs-cTnT ≥16 ng/L had the same percentage of MACE at 5-year follow-up (33{\%}) as patients with presentation MACE. CONCLUSIONS: Many patients with ACS ruled out and putatively normal but detectable hs-cTnI concentrations are at similar long-term risk as those with MACE. hscTnT concentrations are more strongly associated with 5-year mortality than hs-cTnI.",
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T1 - Detectable high-sensitivity cardiac troponin within the population reference interval conveys high 5-year cardiovascular risk

T2 - An observational study

AU - Than, Martin P.

AU - Aldous, Sally J.

AU - Troughton, Richard W.

AU - Pemberton, Christopher J.

AU - Richards, A. Mark

AU - Frampton, Christopher M.A.

AU - Florkowski, Christopher M.

AU - George, Peter M.

AU - Bailey, Samantha

AU - Young, Joanna M.

AU - Cullen, Louise

AU - Greenslade, Jaimi H.

AU - Parsonage, William A.

AU - Everett, Brendan M.

AU - Peacock, W. Frank

AU - Jaffe, Allan S

AU - Pickering, John W.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - BACKGROUND: Increased cardiac troponin I or T detected by high-sensitivity assays (hs-cTnI or hs-cTnT) confers an increased risk of adverse prognosis. We determined whether patients presenting with putatively normal, detectable cTn concentrations [limit of detection and upper reference limit (URL)] have increased risk of major adverse cardiovascular events (MACE) or all-cause mortality. METHODS: A prospective 5-year follow-up of patients recruited in the emergency department with possible acute coronary syndrome (ACS) and cTn concentrations measured with hs-cTnI (Abbott) and hs-cTnT (Roche) assays. Cox regression models were generated with adjustment for covariates in those withoutMACEon presentation. Hazard ratios (HRs) for hs-cTn were calculated relative to the HRs at the median concentration. RESULTS: Of 1113 patients, 836 were without presentation MACE. Of these, 138 incurred a MACE and 169 died during a median 5.8-year follow-up. HRs for MACE at the URLs were 2.3 (95% CI, 1.7-3.2) for hs-cTnI and 1.8 (95% CI, 1.3-2.4) for hs-cTnT. Corresponding HRs for mortality were 1.7 (95% CI, 1.2-2.2) for hs-cTnI and 2.3 (95 % CI, 1.7-3.1) for hs-cTnT. The HR for MACE increased with increasing hs-cTn concentration similarly for both assays, but the HR for mortality increased at approximately twice the rate for hs-cTnT than hs-cTnI. Patients with hs-cTnI ≥10 ng/L or hs-cTnT ≥16 ng/L had the same percentage of MACE at 5-year follow-up (33%) as patients with presentation MACE. CONCLUSIONS: Many patients with ACS ruled out and putatively normal but detectable hs-cTnI concentrations are at similar long-term risk as those with MACE. hscTnT concentrations are more strongly associated with 5-year mortality than hs-cTnI.

AB - BACKGROUND: Increased cardiac troponin I or T detected by high-sensitivity assays (hs-cTnI or hs-cTnT) confers an increased risk of adverse prognosis. We determined whether patients presenting with putatively normal, detectable cTn concentrations [limit of detection and upper reference limit (URL)] have increased risk of major adverse cardiovascular events (MACE) or all-cause mortality. METHODS: A prospective 5-year follow-up of patients recruited in the emergency department with possible acute coronary syndrome (ACS) and cTn concentrations measured with hs-cTnI (Abbott) and hs-cTnT (Roche) assays. Cox regression models were generated with adjustment for covariates in those withoutMACEon presentation. Hazard ratios (HRs) for hs-cTn were calculated relative to the HRs at the median concentration. RESULTS: Of 1113 patients, 836 were without presentation MACE. Of these, 138 incurred a MACE and 169 died during a median 5.8-year follow-up. HRs for MACE at the URLs were 2.3 (95% CI, 1.7-3.2) for hs-cTnI and 1.8 (95% CI, 1.3-2.4) for hs-cTnT. Corresponding HRs for mortality were 1.7 (95% CI, 1.2-2.2) for hs-cTnI and 2.3 (95 % CI, 1.7-3.1) for hs-cTnT. The HR for MACE increased with increasing hs-cTn concentration similarly for both assays, but the HR for mortality increased at approximately twice the rate for hs-cTnT than hs-cTnI. Patients with hs-cTnI ≥10 ng/L or hs-cTnT ≥16 ng/L had the same percentage of MACE at 5-year follow-up (33%) as patients with presentation MACE. CONCLUSIONS: Many patients with ACS ruled out and putatively normal but detectable hs-cTnI concentrations are at similar long-term risk as those with MACE. hscTnT concentrations are more strongly associated with 5-year mortality than hs-cTnI.

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