A sensitive cardiac troponin T assay in stable coronary artery disease

Abstract

Background: In most patients with stable coronary artery disease, plasma cardiac troponin T levels are below the limit of detection for the conventional assay. The distribution and determinants of very low circulating troponin T levels, as well as their association with cardiovascular events, in such patients are unknown.

Methods: We used a new, high-sensitivity assay to determine the concentration of cardiac troponin T in plasma samples from 3679 patients with stable coronary artery disease and preserved left ventricular function. Results of the assay were analyzed in relation to the incidence of cardiovascular events during a median follow-up period of 5.2 years.

Results: With the highly sensitive assay, concentrations of cardiac troponin T were at or above the limit of detection (0.001 microg per liter) in 3593 patients (97.7%) and at or above the 99th percentile for apparently healthy subjects (0.0133 microg per liter) in 407 patients (11.1%). After adjustment for other independent prognostic indicators, there was a strong and graded increase in the cumulative incidence of cardiovascular death (adjusted hazard ratio per unit increase in the natural logarithm of the troponin T level, 2.09; 95% confidence interval [CI], 1.60 to 2.74; P<0.001) and of heart failure (adjusted hazard ratio, 2.20; 95% CI, 1.66 to 2.90; P<0.001) in this study group. Increased risk associated with higher levels of troponin T was evident well below the limit of detection of conventional cardiac troponin T assays and below the 99th percentile of values in a healthy population. There was no association between troponin T levels as measured with the highly sensitive assay and the incidence of myocardial infarction (adjusted hazard ratio, 1.16; 95% CI, 0.97 to 1.40; P=0.11).

Conclusions: After adjustment for other independent prognostic indicators, cardiac troponin T concentrations as measured with a highly sensitive assay were significantly associated with the incidence of cardiovascular death and heart failure but not with myocardial infarction in patients with stable coronary artery disease.

Figure 1

Distribution of High-Sensitivity Cardiac Troponin T in Patients with Stable Coronary Artery Disease (CAD) and in Apparently Healthy Blood Donors.

Figure 2

Incidence of Cardiovascular Death According to Quartile of High-Sensitivity Cardiac Troponin T Level.

Figure 3. Covariate-Adjusted Receiver-Operating-Characteristic Plots for the Use of High-Sensitivity Cardiac Troponin T to Predict the Risk of Cardiovascular Death

Panel A shows the curves for the model adjusted for treatment assignment, age, sex, smoking status, and high-sensitivity C-reactive protein level. Panel B shows the curves for the model that included these with the addition of the N-terminal pro–brain natriuretic peptide level.