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
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.
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- 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
Citation
ISSN
Publication Date
Volume
Start / End Page
Publisher
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