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. 2009 Dec 24;361(26):2538-47.
doi: 10.1056/NEJMoa0805299. Epub 2009 Nov 25.

A sensitive cardiac troponin T assay in stable coronary artery disease

Torbjørn Omland  1 , James A de Lemos, Marc S Sabatine, Costas A Christophi, Madeline Murguia Rice, Kathleen A Jablonski, Solve Tjora, Michael J Domanski, Bernard J Gersh, Jean L Rouleau, Marc A Pfeffer, Eugene Braunwald; Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial Investigators
Affiliations

A sensitive cardiac troponin T assay in stable coronary artery disease

Torbjørn Omland et al. N Engl J Med. .

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.

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Figures

Figure 1
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
Figure 2
Incidence of Cardiovascular Death According to Quartile of High-Sensitivity Cardiac Troponin T Level.
Figure 3
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.
See this image and copyright information in PMC

Comment in

  • Sensitive cardiac troponin T assay.
    Lippi G, Cervellin G, Plebani M. Lippi G, et al. N Engl J Med. 2010 Apr 1;362(13):1242; author reply 1243. doi: 10.1056/NEJMc1000952. N Engl J Med. 2010. PMID: 20357290 No abstract available.
  • Sensitive cardiac troponin T assay.
    Mazurek JA. Mazurek JA. N Engl J Med. 2010 Apr 1;362(13):1242-3; author reply 1243. N Engl J Med. 2010. PMID: 20364457 No abstract available.

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