Prognostic value of cardiac troponin I measured with a highly sensitive assay in patients with stable coronary artery disease

J Am Coll Cardiol. 2013 Mar 26;61(12):1240-9. doi: 10.1016/j.jacc.2012.12.026. Epub 2013 Feb 13.


Objectives: The aims of this study were to assess the prognostic value of cardiac troponin I levels, measured with a new high-sensitivity assay, in low-risk patients with stable coronary artery disease (CAD) and to contrast its determinants and prognostic merit with that of high-sensitivity cardiac troponin T (hs-TnT).

Background: New, highly sensitive cardiac troponin assays permit evaluation of the association between troponin levels and outcomes in patients with stable CAD.

Methods: High-sensitivity cardiac troponin I (hs-TnI) levels at baseline were assessed in 3,623 patients with stable CAD and preserved systolic function enrolled in the PEACE (Prevention of Events With Angiotensin-Converting Enzyme Inhibitor Therapy) trial.

Results: In total, 98.5% of patients had hs-TnI concentrations higher than the detection level (1.2 pg/ml). hs-TnI correlated moderately with hs-TnT (r = 0.44) and N-terminal pro-B-type natriuretic peptide (r = 0.39) but only weakly with age (r = 0.17) and estimated glomerular filtration rate (r = -0.11). During a median follow-up period of 5.2 years, 203 patients died of cardiovascular causes or were hospitalized for heart failure, and 209 patients had nonfatal myocardial infarctions. In analyses adjusting for conventional risk markers, N-terminal pro-B-type natriuretic peptide, and hs-TnT, hs-TnI levels in the fourth compared with the 3 lower quartiles were associated with the incidence of cardiovascular death or heart failure (hazard ratio: 1.84; 95% confidence interval: 1.30 to 2.61; p < 0.001). [corrected]. There was a [corrected] weaker association with nonfatal myocardial infarction (hazard ratio: 1.37; 95% confidence interval: 0.98 to 1.92; p = 0.066). [corrected]. In the same models, hs-TnT concentrations were associated with the incidence of cardiovascular death or heart failure but not of myocardial infarction.

Conclusions: In patients with stable CAD, hs-TnI concentrations are associated with cardiovascular risk independently of conventional risk markers and hs-TnT. (Prevention of Events With Angiotensin-Converting Enzyme Inhibitor Therapy [PEACE]; NCT00000558).

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Cause of Death
  • Coronary Artery Disease / blood*
  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / drug therapy
  • Coronary Artery Disease / mortality
  • Follow-Up Studies
  • Glomerular Filtration Rate / drug effects
  • Glomerular Filtration Rate / physiology
  • Heart Failure / blood
  • Heart Failure / diagnosis
  • Heart Failure / drug therapy
  • Heart Failure / mortality
  • Humans
  • Indoles / therapeutic use
  • Myocardial Infarction / blood
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / mortality
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • Prognosis
  • Risk Factors
  • Statistics as Topic
  • Survival Rate
  • Troponin I / blood*
  • United States


  • Angiotensin-Converting Enzyme Inhibitors
  • Indoles
  • Peptide Fragments
  • Troponin I
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • trandolapril

Associated data