High-Sensitivity Troponin I and Coronary Computed Tomography in Symptomatic Outpatients With Suspected CAD: Insights From the PROMISE Trial.
Aged
Biomarkers
/ blood
Computed Tomography Angiography
Coronary Angiography
/ methods
Coronary Artery Disease
/ blood
Coronary Stenosis
/ blood
Female
Humans
Male
Middle Aged
North America
/ epidemiology
Outpatients
Predictive Value of Tests
Prevalence
Prognosis
Risk Assessment
Risk Factors
Severity of Illness Index
Troponin I
/ blood
Up-Regulation
Vascular Calcification
/ blood
coronary artery disease
coronary computed tomography angiography
troponin
Journal
JACC. Cardiovascular imaging
ISSN: 1876-7591
Titre abrégé: JACC Cardiovasc Imaging
Pays: United States
ID NLM: 101467978
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
08
12
2017
revised:
16
01
2018
accepted:
18
01
2018
pubmed:
20
3
2018
medline:
19
3
2020
entrez:
19
3
2018
Statut:
ppublish
Résumé
The goal of this study was to examine associations between concentrations of high-sensitivity troponin I (hsTnI) (measured by using a single-molecule counting method) and obstructive coronary artery disease (CAD) in 1,844 stable, symptomatic outpatients with suspected CAD randomized to undergo coronary computed tomography angiography (CTA) in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial. Elevated concentrations of hsTnI are associated with CAD in patients with myocardial infarction. The meaning of hsTnI concentrations in stable symptomatic outpatients is not well understood. Clinical characteristics and CTA results (including coronary artery calcium [CAC] scores) were expressed across hsTnI quartiles. Determinants of hsTnI concentration were identified. Multivariable logistic regression identified independent predictors of obstructive CAD The median hsTnI concentration was 1.5 ng/l; nearly all (98.5%) subjects had measurable hsTnI, and 6.1% had concentrations ≥99th percentile concentration for this assay (6 ng/l). Higher CAC scores, as well as more prevalent and diffuse CAD, was seen in upper hsTnI quartiles (all p < 0.001). Independent predictors of hsTnI concentrations included age, sex, and CAC score (all p < 0.05). After adjusting for demographic and clinical characteristics, log-transformed hsTnI concentrations were associated with obstructive CAD In stable symptomatic outpatients undergoing nonemergent coronary CTA for the diagnosis of suspected CAD, higher concentrations of hsTnI were associated with increasing presence and severity of coronary atherosclerosis. (Prospective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550).
Sections du résumé
OBJECTIVES
The goal of this study was to examine associations between concentrations of high-sensitivity troponin I (hsTnI) (measured by using a single-molecule counting method) and obstructive coronary artery disease (CAD) in 1,844 stable, symptomatic outpatients with suspected CAD randomized to undergo coronary computed tomography angiography (CTA) in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial.
BACKGROUND
Elevated concentrations of hsTnI are associated with CAD in patients with myocardial infarction. The meaning of hsTnI concentrations in stable symptomatic outpatients is not well understood.
METHODS
Clinical characteristics and CTA results (including coronary artery calcium [CAC] scores) were expressed across hsTnI quartiles. Determinants of hsTnI concentration were identified. Multivariable logistic regression identified independent predictors of obstructive CAD
RESULTS
The median hsTnI concentration was 1.5 ng/l; nearly all (98.5%) subjects had measurable hsTnI, and 6.1% had concentrations ≥99th percentile concentration for this assay (6 ng/l). Higher CAC scores, as well as more prevalent and diffuse CAD, was seen in upper hsTnI quartiles (all p < 0.001). Independent predictors of hsTnI concentrations included age, sex, and CAC score (all p < 0.05). After adjusting for demographic and clinical characteristics, log-transformed hsTnI concentrations were associated with obstructive CAD
CONCLUSIONS
In stable symptomatic outpatients undergoing nonemergent coronary CTA for the diagnosis of suspected CAD, higher concentrations of hsTnI were associated with increasing presence and severity of coronary atherosclerosis. (Prospective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550).
Identifiants
pubmed: 29550314
pii: S1936-878X(18)30132-3
doi: 10.1016/j.jcmg.2018.01.021
pmc: PMC6129434
mid: NIHMS939909
pii:
doi:
Substances chimiques
Biomarkers
0
Troponin I
0
Banques de données
ClinicalTrials.gov
['NCT01174550']
Types de publication
Journal Article
Multicenter Study
Pragmatic Clinical Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1047-1055Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR002548
Pays : United States
Organisme : NHLBI NIH HHS
ID : K24 HL113128
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL098237
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL098236
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL098305
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : ErratumIn
Informations de copyright
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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