High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort.
BACKGROUND: Recent studies have demonstrated the association between increased concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and the incidence of myocardial infarction, heart failure, and mortality. However, most prognostic studies to date focus on the value of hs-cTnT in the elder...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2012-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3338816?pdf=render |
| _version_ | 1811288700683812864 |
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| author | Alma M Mingels Ivo A Joosen Mathijs O Versteylen Eduard M Laufer Mark H Winkens Joachim E Wildberger Marja P Van Dieijen-Visser Leonard Hofstra |
| author_facet | Alma M Mingels Ivo A Joosen Mathijs O Versteylen Eduard M Laufer Mark H Winkens Joachim E Wildberger Marja P Van Dieijen-Visser Leonard Hofstra |
| author_sort | Alma M Mingels |
| collection | DOAJ |
| description | BACKGROUND: Recent studies have demonstrated the association between increased concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and the incidence of myocardial infarction, heart failure, and mortality. However, most prognostic studies to date focus on the value of hs-cTnT in the elderly or general population. The value of hs-cTnT in symptomatic patients visiting the outpatient department remains unclear. The aim of this study was to investigate the prognostic value of hs-cTnT as a biomarker in patients with symptoms of chest discomfort suspected for coronary artery disease and to assess its additional value in combination with other risk stratification tools in predicting cardiac events. METHODS: We studied 1,088 patients (follow-up 2.2 ± 0.8 years) with chest discomfort who underwent coronary calcium scoring and coronary CT-angiography. Traditional cardiovascular risk factors and concentrations of hs-cTnT, N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP) were assessed. Study endpoint was the occurrence of late coronary revascularization (>90 days), acute coronary syndrome, and cardiac mortality. RESULTS: Hs-cTnT was a significant predictor for the composite endpoint (highest quartile [Q4]>6.7 ng/L, HR 3.55; 95%CI 1.88-6.70; P<0.001). Survival analysis showed that hs-cTnT had significant predictive value on top of current risk stratification tools (Chi-square change P<0.01). In patients with hs-cTnT in Q4 versus <Q4, a 2- to 3-fold increase in cardiovascular risk was noticed, either when corrected for high or low Framingham risk score, coronary calcium scoring, or CT-angiography assessment (HR 3.11; 2.73; 2.47; respectively; all P<0.01). This was not the case for hsCRP and NT-proBNP. CONCLUSIONS: Hs-cTnT is a useful prognostic biomarker in patients with chest discomfort suspected for coronary artery disease. In addition, hs-cTnT was an independent predictor for cardiac events when corrected for cardiovascular risk profiling, calcium score and CT-angiography results. |
| first_indexed | 2024-04-13T03:41:56Z |
| format | Article |
| id | doaj.art-eee5f768973540c0bc99f0c5a6611c6d |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-13T03:41:56Z |
| publishDate | 2012-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-eee5f768973540c0bc99f0c5a6611c6d2022-12-22T03:04:09ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-0174e3505910.1371/journal.pone.0035059High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort.Alma M MingelsIvo A JoosenMathijs O VersteylenEduard M LauferMark H WinkensJoachim E WildbergerMarja P Van Dieijen-VisserLeonard HofstraBACKGROUND: Recent studies have demonstrated the association between increased concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and the incidence of myocardial infarction, heart failure, and mortality. However, most prognostic studies to date focus on the value of hs-cTnT in the elderly or general population. The value of hs-cTnT in symptomatic patients visiting the outpatient department remains unclear. The aim of this study was to investigate the prognostic value of hs-cTnT as a biomarker in patients with symptoms of chest discomfort suspected for coronary artery disease and to assess its additional value in combination with other risk stratification tools in predicting cardiac events. METHODS: We studied 1,088 patients (follow-up 2.2 ± 0.8 years) with chest discomfort who underwent coronary calcium scoring and coronary CT-angiography. Traditional cardiovascular risk factors and concentrations of hs-cTnT, N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP) were assessed. Study endpoint was the occurrence of late coronary revascularization (>90 days), acute coronary syndrome, and cardiac mortality. RESULTS: Hs-cTnT was a significant predictor for the composite endpoint (highest quartile [Q4]>6.7 ng/L, HR 3.55; 95%CI 1.88-6.70; P<0.001). Survival analysis showed that hs-cTnT had significant predictive value on top of current risk stratification tools (Chi-square change P<0.01). In patients with hs-cTnT in Q4 versus <Q4, a 2- to 3-fold increase in cardiovascular risk was noticed, either when corrected for high or low Framingham risk score, coronary calcium scoring, or CT-angiography assessment (HR 3.11; 2.73; 2.47; respectively; all P<0.01). This was not the case for hsCRP and NT-proBNP. CONCLUSIONS: Hs-cTnT is a useful prognostic biomarker in patients with chest discomfort suspected for coronary artery disease. In addition, hs-cTnT was an independent predictor for cardiac events when corrected for cardiovascular risk profiling, calcium score and CT-angiography results.http://europepmc.org/articles/PMC3338816?pdf=render |
| spellingShingle | Alma M Mingels Ivo A Joosen Mathijs O Versteylen Eduard M Laufer Mark H Winkens Joachim E Wildberger Marja P Van Dieijen-Visser Leonard Hofstra High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort. PLoS ONE |
| title | High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort. |
| title_full | High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort. |
| title_fullStr | High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort. |
| title_full_unstemmed | High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort. |
| title_short | High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort. |
| title_sort | high sensitivity cardiac troponin t risk stratification tool in patients with symptoms of chest discomfort |
| url | http://europepmc.org/articles/PMC3338816?pdf=render |
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