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Relation of High-sensitivity Cardiac Troponin I Elevation With Exercise to Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease

The American journal of cardiology, 2020-12, Vol.136, p.1-8 [Peer Reviewed Journal]

2020 Elsevier Inc. ;Copyright © 2020 Elsevier Inc. All rights reserved. ;2020. Elsevier Inc. ;ISSN: 0002-9149 ;EISSN: 1879-1913 ;DOI: 10.1016/j.amjcard.2020.09.019 ;PMID: 32941818

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Title:
Relation of High-sensitivity Cardiac Troponin I Elevation With Exercise to Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease
Author: Lima, Bruno B. ; Hammadah, Muhammad ; Kim, Jeong Hwan ; Uphoff, Irina ; Shah, Amit ; Levantsevych, Oleksiy ; Almuwaqqat, Zakaria ; Moazzami, Kasra ; Sullivan, Samaah ; Ward, Laura ; Sun, Yan ; Kutner, Michael ; Ko, Yi-An ; Sheps, David S ; Beshiri, Agim ; Murtagh, Gillian ; Bremner, J Douglas ; Vaccarino, Viola ; Quyyumi, Arshed A.
Subjects: Aged ; Angina ; Angina pectoris ; Calcium-binding protein ; Cardiac stress tests ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - blood ; Cardiovascular Diseases - complications ; Cardiovascular Diseases - physiopathology ; Cohort Studies ; Confidence intervals ; Coronary artery ; Coronary artery disease ; Coronary Artery Disease - blood ; Coronary Artery Disease - complications ; Coronary Artery Disease - physiopathology ; Coronary vessels ; Exercise Test ; Female ; Fitness equipment ; Hazards ; Health hazards ; Health risks ; Heart diseases ; Heart failure ; Humans ; Ischemia ; Male ; Median (statistics) ; Middle Aged ; Myocardial infarction ; Myocardial ischemia ; Perfusion ; Risk analysis ; Risk factors ; Sensitivity and Specificity ; Single photon emission computed tomography ; Statistical analysis ; Stress ; Treadmills ; Troponin ; Troponin I ; Troponin I - blood ; Variables
Is Part Of: The American journal of cardiology, 2020-12, Vol.136, p.1-8
Description: High sensitive cardiac troponin I (hs-cTnI) increases with inducible myocardial ischemia in patients with coronary artery disease (CAD). We aimed to assess if the change in hs-cTnI levels with exercise stress testing is associated with major adverse cardiac events (MACE). A cohort of 365 (age 62 ± 9 years, 77% men) patients with stable CAD underwent 99mTc sestamibi myocardial perfusion imaging with treadmill testing. Plasma hs-cTnI level was measured at rest and at 45 min after stress. Multivariable Fine & Gray's subdistribution hazards models were used to determine the association between the change in hs-cTnI and MACE, a composite end point of cardiovascular death, myocardial infarction, and unstable angina requiring revascularization. During a median follow-up of 3 years, 39 (11%) patients experienced MACE. After adjustment, for each two-fold increment in hs-cTnI with stress, there was a 2.2 (95% confidence interval 1.3-3.6)-fold increase in the hazard for MACE. Presence of both a high resting hs-cTnI level (>median) and ≥ 20% stress-induced hs-cTnI elevation was associated with the highest incidence of MACE (subdistribution hazards models 4.6, 95% confidence interval 1.6 to 13.0) compared with low levels of both. Risk discrimination statistics significantly improved after addition of resting and change in hs-cTnI levels to a model including traditional risk factors and inducible ischemia (0.67 to 0.71). Conversely, adding inducible ischemia by SPECT did not significantly improve the C-statistic from a model including traditional risk factors, baseline and change in hs-cTnI (0.70 to 0.71). In stable CAD patients, higher resting levels and elevation of hs-cTnI with exercise are predictors of adverse cardiovascular outcomes beyond traditional cardiovascular risk factors and presence of inducible ischemia.
Publisher: United States: Elsevier Inc
Language: English
Identifier: ISSN: 0002-9149
EISSN: 1879-1913
DOI: 10.1016/j.amjcard.2020.09.019
PMID: 32941818
Source: MEDLINE
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Relation of High-sensitivity Cardiac Troponin I Elevation With Exercise to Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease

2020 Elsevier Inc. ;Copyright © 2020 Elsevier Inc. All rights reserved. ;2020. Elsevier Inc. ;ISSN: 0002-9149 ;EISSN: 1879-1913 ;DOI: 10.1016/j.amjcard.2020.09.019 ;PMID: 32941818

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