gms | German Medical Science

MAINZ//2011: 56. GMDS-Jahrestagung und 6. DGEpi-Jahrestagung

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V.
Deutsche Gesellschaft für Epidemiologie e. V.

26. - 29.09.2011 in Mainz

High-sensitivity troponin T and risk of recurrent cardiovascular disease events in patients with stable coronary heart disease followed over 8-years

Meeting Abstract

  • Wolfgang Koenig - Dept. of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm
  • Lutz P Breitling - Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg
  • Hermann Brenner - Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg
  • Dietrich Rothenbacher - Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany

Mainz//2011. 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi). Mainz, 26.-29.09.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11gmds161

DOI: 10.3205/11gmds161, URN: urn:nbn:de:0183-11gmds1612

Veröffentlicht: 20. September 2011

© 2011 Koenig et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: The clinical relevance of only slightly elevated circulating troponin levels in patients with stable coronary heart disease (CHD) several weeks after an acute event has not been fully evaluated. We aimed to assess the predictive value of a new high-sensitivity troponin T assay (hsTnT) for recurrent cardiovascular disease (CVD) events in stable CHD patients, simultaneously controlling for a large number of potential confounders.

Material & Methods: Plasma concentrations of hsTnT (Roche Elecsys) were measured at baseline in a cohort of 1,050 patients aged 30-70 years with CHD. The Cox proportional hazards model was used to determine the prognostic value of hsTnT on a combined CVD endpoint after adjustment for covariates.

Results: The median hsTnT level was 10.9 µg/L (IQR 5.1-18.9). Elevated hsTnT levels were associated with higher age, history of hypertension, history of diabetes, a higher number of affected vessels, initial management of CHD, and left-ventricular dysfunction. In addition as determined by 12-lead routine ECG, rhythm disorders, and anterior wall infarction were associated with higher hsTNT. Furthermore, HsTnT was highly correlated with NT-proBNP and cystatin C (R=0.61 and R=0.32, respectively, both p-values <0.0001). During a median follow-up of 8.1 years, 150 patients (21.0%) experienced a fatal- or non-fatal secondary CVD event. In a multivariate model, hsTnT was associated with a hazard ratio (HR) of secondary CVD events of 2.83 (95% CI, 1.68-4.79) when extreme quartiles were compared. Further adjustment for cystatin C, NT-proBNP, and CRP attenuated the association only slightly (2.27; 95% CI, 1.31-3.95), p for trend <0.002). ROC analysis of a clinical model which included hsTnT to a baseline model showed a modest improvement in the AUC (0.69 vs 0.67)

Conclusions: Slightly elevated hsTnT levels in stable CHD patients are associated with a number of CVD disorders and predict long-term CVD events in these patients.