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Prognostic Value of High-Sensitivity Cardiac Troponin T Compared with Risk Scores in Stable Cardiovascular Disease
- Source :
- The American journal of medicine. 130(5)
- Publication Year :
- 2016
-
Abstract
- Risk stratification of patients with cardiovascular disease remains challenging despite consideration of risk scores.We aimed to evaluate the prognostic performance of high-sensitivity cardiac troponin T in a low-risk outpatient population presenting for nonsecondary and secondary prevention. All-cause mortality, a composite of all-cause mortality, acute myocardial infarction, and stroke (end point 2), and a composite of all-cause mortality, acute myocardial infarction, stroke and rehospitalization for acute coronary syndrome, and decompensated heart failure (end point 3) were defined. The prognostic performance of high-sensitivity cardiac troponin T on index visit was compared with the PROCAM score and 3 FRAMINGHAM subscores.In 693 patients with a median follow-up of 796 days, we observed 16 deaths, 32 patients with end point 2, and 83 patients with end point 3. All risk scores performed better in the prediction of all-cause mortality in nonsecondary prevention (area under the curve [AUC]: PROCAM: 0.922 vs 0.523, P = .001, consistent for all other scores). In secondary prevention, high-sensitivity cardiac troponin T outperformed all risk scores in the prediction of all-cause mortality (ΔAUC: PROCAM: 0.319, P.001, consistent for all other scores) and performed superiorly in the prediction of end point 2 compared with the PROCAM, FRAMINGHAM-Coronary Heart Disease, and FRAMINGHAM-Hard Coronary Heart Disease scores (ΔAUC: PROCAM: 0.176, P = .047, consistent for FRAMINGHAM-Coronary Heart Disease and FRAMINGHAM-Hard Coronary Heart Disease). In nonsecondary prevention, we observed a comparable prognostic performance of high-sensitivity cardiac troponin T and multivariable risk scores. Our findings on the prediction of all-cause mortality compared with the FRAMINGHAM-Hard Coronary Heart Disease score were confirmed in an independent validation cohort on 2046 patients.High-sensitivity troponin T provides excellent risk stratification regarding all-cause mortality and all-cause mortality, acute myocardial infarction, and stroke in a secondary prevention cohort in whom risk scores perform poorly.
- Subjects :
- Male
medicine.medical_specialty
Acute coronary syndrome
Heart disease
Population
Myocardial Infarction
030204 cardiovascular system & hematology
Risk Assessment
Sensitivity and Specificity
03 medical and health sciences
0302 clinical medicine
Troponin T
Internal medicine
Cause of Death
medicine
Secondary Prevention
Humans
030212 general & internal medicine
Myocardial infarction
education
Stroke
Aged
Heart Failure
education.field_of_study
Framingham Risk Score
business.industry
General Medicine
Middle Aged
medicine.disease
Prognosis
Cardiovascular Diseases
Heart failure
Cardiology
Female
business
Biomarkers
Subjects
Details
- ISSN :
- 15557162
- Volume :
- 130
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- The American journal of medicine
- Accession number :
- edsair.doi.dedup.....69d2f7a807fffecb5acbdc9bcbb1a6d8