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Single-Molecule hsTnI and Short-Term Risk in Stable Patients With Chest Pain.

Publication ,  Journal Article
Januzzi, JL; Suchindran, S; Hoffmann, U; Patel, MR; Ferencik, M; Coles, A; Tardif, J-C; Ginsburg, GS; Douglas, PS; PROMISE Investigators,
Published in: J Am Coll Cardiol
January 29, 2019

BACKGROUND: Evaluation of stable symptomatic outpatients with suspected coronary artery disease (CAD) may be challenging because they have a wide range of cardiovascular risk. The role of troponin testing to assist clinical decision making in this setting is unexplored. OBJECTIVES: This study sought to evaluate the prognostic meaning of single-molecule counting high-sensitivity troponin I (hsTnI) (normal range <6 ng/l) among outpatients with stable chest symptoms and suspected CAD. METHODS: Participants with available blood samples in PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) were studied, and hsTnI results were analyzed relative to the primary outcome of death, acute myocardial infarction (MI), or hospitalization for unstable angina by 1 year. The secondary outcome was the composite of cardiovascular death or acute MI. RESULTS: The study sample consisted of 4,021 participants; 98.6% had measurable hsTnI concentrations. The median hsTnI value was 1.6 ng/l. In upper hsTnI quartiles, patients had higher-risk clinical profiles. Higher hsTnI concentrations were associated with greater event probabilities for death, acute MI, or hospitalization for unstable angina. In multivariable models, hsTnI concentrations independently predicted death, acute MI, or hospitalization for unstable angina (hazard ratio: 1.54 per increase in log-hsTnI interquartile range; p < 0.001) and cardiovascular death or acute MI (hazard ratio: 1.52 per increase in log-hsTnI interquartile range; p < 0.001) and were particularly associated with near-term events, compared with longer follow-up. CONCLUSIONS: In symptomatic outpatients with suspected CAD, higher concentrations of hsTnI within the normal range were associated with heightened near-term risk for death, acute MI, or hospitalization. (Prospective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 29, 2019

Volume

73

Issue

3

Start / End Page

251 / 260

Location

United States

Related Subject Headings

  • Troponin I
  • Prospective Studies
  • North America
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiovascular System & Hematology
  • Biomarkers
  • Angina, Stable
 

Citation

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ICMJE
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Januzzi, J. L., Suchindran, S., Hoffmann, U., Patel, M. R., Ferencik, M., Coles, A., … PROMISE Investigators, . (2019). Single-Molecule hsTnI and Short-Term Risk in Stable Patients With Chest Pain. J Am Coll Cardiol, 73(3), 251–260. https://doi.org/10.1016/j.jacc.2018.10.065
Januzzi, James L., Sunil Suchindran, Udo Hoffmann, Manesh R. Patel, Maros Ferencik, Adrian Coles, Jean-Claude Tardif, Geoffrey S. Ginsburg, Pamela S. Douglas, and Pamela S. PROMISE Investigators. “Single-Molecule hsTnI and Short-Term Risk in Stable Patients With Chest Pain.J Am Coll Cardiol 73, no. 3 (January 29, 2019): 251–60. https://doi.org/10.1016/j.jacc.2018.10.065.
Januzzi JL, Suchindran S, Hoffmann U, Patel MR, Ferencik M, Coles A, et al. Single-Molecule hsTnI and Short-Term Risk in Stable Patients With Chest Pain. J Am Coll Cardiol. 2019 Jan 29;73(3):251–60.
Januzzi, James L., et al. “Single-Molecule hsTnI and Short-Term Risk in Stable Patients With Chest Pain.J Am Coll Cardiol, vol. 73, no. 3, Jan. 2019, pp. 251–60. Pubmed, doi:10.1016/j.jacc.2018.10.065.
Januzzi JL, Suchindran S, Hoffmann U, Patel MR, Ferencik M, Coles A, Tardif J-C, Ginsburg GS, Douglas PS, PROMISE Investigators. Single-Molecule hsTnI and Short-Term Risk in Stable Patients With Chest Pain. J Am Coll Cardiol. 2019 Jan 29;73(3):251–260.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 29, 2019

Volume

73

Issue

3

Start / End Page

251 / 260

Location

United States

Related Subject Headings

  • Troponin I
  • Prospective Studies
  • North America
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiovascular System & Hematology
  • Biomarkers
  • Angina, Stable