Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyOctober 2023
Observational data support the utility of troponin outside of acute care.
We use troponin every day in the acute-care setting to identify patients with myocardial injury, but does it also have utility in risk stratification for people not suspected of having an acute coronary syndrome? Prior studies indicate that high-sensitivity cardiac troponin levels have prognostic value for people with asymptomatic coronary artery disease or a history of acute coronary syndrome. However, the value for people with stable angina and known coronary artery disease is not known.
This prospective cohort study sought to evaluate the prognostic importance of high-sensitivity cardiac troponin I (hs-cTnI) levels for people with chronic coronary artery disease. The investigators enrolled 4240 consecutive patients referred for coronary angiography to evaluate symptoms of stable angina. Their median age was 66 years and 33% were women.
During a median follow up of 2.4 years, 255 patients (6%) experienced a primary outcome event – i.e. myocardial infarction or cardiovascular death. For the 3888 patients (92%) identified with chronic coronary artery disease, troponin concentrations were significantly associated with risk for the primary outcome (case-specific hazard ratio [HR], 3.3, log10 hs-cTnI). After adjustment for other factors, the relationship was attenuated but persisted (adjusted HR, 2.6).
Comment: This study adds to the literature supporting the utility of hs-cTnI for risk stratification in the nonacute setting. To date, these tests are not recommended, but their independent prognostic value suggests that there may be value in escalating preventive treatments based on troponin concentration – a strategy that seems worth testing in trials.
Harlan M. Krumholz, MD, SM, Harold H. Hines, Jr. Professor of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, USA.
Wereski R, et al. High-sensitivity cardiac troponin for risk assessment in patients with chronic coronary artery disease. J Am Coll Cardiol 2023; 82: 473-485.
This summary is taken from the following Journal Watch title: Cardiology.