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High Sensitivity Troponin I Measurement in Symptomatic Outpatients With Suspected Coronary Artery Disease: Results From the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) Study

Publication ,  Conference
Januzzi, JL; Suchindran, S; Coles, A; Ferencik, M; Patel, MR; Hoffmann, U; Ginsburg, GS; Douglas, PS
2017

Introduction: Higher concentrations of troponin (Tn) I are associated with prevalent coronary artery disease (CAD) in patients with myocardial infarction. The meaning of TnI concentrations in less acute patients is not well-understood.Hypothesis: Among symptomatic outpatients with suspected CAD, we hypothesized concentrations of TnI measured using a single molecule counting highly sensitive (hs) assay (SMC™ cTnI, Singulex, Inc; Alameda, CA) would be associated with presence and extent of CAD.Methods: We analyzed 1844 participants from the PROMISE study randomized to coronary computed tomography angiography (CTA) with available blood samples for hsTnI measurement. 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 CAD50 (>=50% stenosis in any vessel) and CAD70(>=70% stenosis or >=50% left main).Results: Nearly all (98.5%) subjects had a measurable hsTnI; median hsTnI concentration was 1.5 ng/L, with 6.1% at or above the 99th percentile concentration for this assay (6 ng/L). Across increasing hsTnI quartiles (Table), patients were more likely to be older, to be male, and to have higher blood pressure (all P <0.001). Higher CAC scores, as well as more prevalent and more 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). Ln-transformed hsTnI concentrations predicted obstructive CAD50 (adjusted odds ratio (adjOR 1.15 per interquartile range [IQR]; P=0.02) and CAD70(adjOR 1.25 per IQR; P=0.001).Conclusions: In symptomatic patients with suspected CAD undergoing coronary CTA, higher concentrations of hsTnI within the normal range for this assay were associated with increasing presence and severity of coronary atherosclerosis.Author Disclosures: J.L. Januzzi: Research Grant; Significant; Roche, Singulex, Prevencio, Novartis. Consultant/Advisory Board; Significant; Critical Diagnostics, Janacare, Philips, Abbott. S. Suchindran: None. A. Coles: None. M. Ferencik: None. M.R. Patel: Research Grant; Significant; Heart Flow Technologies, Jansen, Johnson & Johnson, Astra Zeneca, and AHRQ. Consultant/Advisory Board; Modest; Astra Zeneca, Bayer, and Otsuka. U. Hoffmann: None. G.S. Ginsburg: Research Grant; Significant; Singulex, Abbott, 23andMe. Consultant/Advisory Board; Modest; CardioDx, Interleukin Genetics, Pappas Ventures, Fabric Genomics, Genome Magazine. Other; Modest; Alere, CardioDx, Fabric Genomics, Origin Commercial Advisors, Elsevier. P.S. Douglas: Research Grant; Significant; GE, HeartFlow.

Duke Scholars

ISSN

0009-7322

Publication Date

2017

Volume

136

Start / End Page

A16672 / A16672

Publisher

American Heart Association, Inc.

Related Subject Headings

  • Cardiovascular System & Hematology
  • 4207 Sports science and exercise
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology
 

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Januzzi, J. L., Suchindran, S., Coles, A., Ferencik, M., Patel, M. R., Hoffmann, U., … Douglas, P. S. (2017). High Sensitivity Troponin I Measurement in Symptomatic Outpatients With Suspected Coronary Artery Disease: Results From the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) Study (Vol. 136, pp. A16672–A16672). American Heart Association, Inc.
Januzzi, James L., Sunil Suchindran, Adrian Coles, Maros Ferencik, Manesh R. Patel, Udo Hoffmann, Geoffrey S. Ginsburg, and Pamela S. Douglas. “High Sensitivity Troponin I Measurement in Symptomatic Outpatients With Suspected Coronary Artery Disease: Results From the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) Study,” 136:A16672–A16672. American Heart Association, Inc., 2017.
Januzzi JL, Suchindran S, Coles A, Ferencik M, Patel MR, Hoffmann U, et al. High Sensitivity Troponin I Measurement in Symptomatic Outpatients With Suspected Coronary Artery Disease: Results From the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) Study. In American Heart Association, Inc.; 2017. p. A16672–A16672.
Januzzi JL, Suchindran S, Coles A, Ferencik M, Patel MR, Hoffmann U, Ginsburg GS, Douglas PS. High Sensitivity Troponin I Measurement in Symptomatic Outpatients With Suspected Coronary Artery Disease: Results From the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) Study. American Heart Association, Inc.; 2017. p. A16672–A16672.

ISSN

0009-7322

Publication Date

2017

Volume

136

Start / End Page

A16672 / A16672

Publisher

American Heart Association, Inc.

Related Subject Headings

  • Cardiovascular System & Hematology
  • 4207 Sports science and exercise
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology