Risk stratification in stable coronary artery disease is possible at cardiac troponin levels below conventional detection and is improved by use of N-terminal pro-B-type natriuretic peptide

Stig Lyngbæk; Per Winkel; Jens P Gøtze; Jens Kastrup; Christian Gluud; Hans Jørn Kolmos; Erik Kjøller; Gorm Boje Jensen; Jørgen Fischer Hansen; Per Hildebrandt; Jørgen Hilden; CLARICOR Trial Group

doi:10.1177/2047487313492099

Risk stratification in stable coronary artery disease is possible at cardiac troponin levels below conventional detection and is improved by use of N-terminal pro-B-type natriuretic peptide

Stig Lyngbæk, Per Winkel, Jens P Gøtze, Jens Kastrup, Christian Gluud, Hans Jørn Kolmos, Erik Kjøller, Gorm Boje Jensen, Jørgen Fischer Hansen, Per Hildebrandt, Jørgen Hilden, CLARICOR Trial Group

23 Citations (Scopus)

Abstract

AIMS: Low prevalence of detectable cardiac troponin in healthy people and low-risk patients previously curtailed its use. With a new high-sensitive cardiac troponin assay (hs-cTnT), concentrations below conventional detection may have prognostic value, notably in combination with N-terminal pro-B-type natriuretic peptide (NT-pro-BNP).

METHODS AND RESULTS: Biomarker concentrations were determined from serum obtained at enrolment in the CLARICOR trial involving 4197 patients with stable coronary artery disease (CAD) followed for 2.6 years. Serum hs-cTnT was detectable (above 3 ng/l) in 78% and above the conventional 99th percentile (13.5 ng/l) in 23%. Across all levels of hs-cTnT there was a graded increase in the risk of cardiovascular death after adjustment for known prognostic indicators: hazard ratio (HR) per unit increase in the natural logarithm of the hs-cTnT level, 1.49; 95% confidence interval (CI), 1.23-1.81; similarly for all-cause mortality (HR 1.48, 95% CI 1.29-1.70) and myocardial infarction (HR 1.37, 95% CI 1.13-1.67). Increasing values of hs-cTnT were associated with increased mortality across all values of NT-pro-BNP, but this was particularly prominent when NT-pro-BNP >400 ng/l.

CONCLUSIONS: In patients with stable CAD, any detectable hs-cTnT level is significantly associated with all-cause mortality, cardiovascular death, and myocardial infarction after adjustment for traditional risk factors and NT-pro-BNP. Excess mortality is particularly pronounced in patients with NT-pro-BNP >400 ng/l.

Original language	English
Journal	European Journal of Preventive Cardiology
Volume	21
Issue number	10
Pages (from-to)	1275-1284
Number of pages	10
ISSN	2047-4873
DOIs	https://doi.org/10.1177/2047487313492099
Publication status	Published - 1 Oct 2014

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Lyngbæk, S., Winkel, P., Gøtze, J. P., Kastrup, J., Gluud, C., Kolmos, H. J., Kjøller, E., Jensen, G. B., Hansen, J. F., Hildebrandt, P., Hilden, J., & CLARICOR Trial Group (2014). Risk stratification in stable coronary artery disease is possible at cardiac troponin levels below conventional detection and is improved by use of N-terminal pro-B-type natriuretic peptide. European Journal of Preventive Cardiology, 21(10), 1275-1284. https://doi.org/10.1177/2047487313492099

Risk stratification in stable coronary artery disease is possible at cardiac troponin levels below conventional detection and is improved by use of N-terminal pro-B-type natriuretic peptide. / Lyngbæk, Stig; Winkel, Per; Gøtze, Jens P et al.

In: European Journal of Preventive Cardiology, Vol. 21, No. 10, 01.10.2014, p. 1275-1284.

Research output: Contribution to journal › Journal article › Research › peer-review

Lyngbæk, S, Winkel, P, Gøtze, JP, Kastrup, J, Gluud, C, Kolmos, HJ, Kjøller, E, Jensen, GB, Hansen, JF, Hildebrandt, P, Hilden, J & CLARICOR Trial Group 2014, 'Risk stratification in stable coronary artery disease is possible at cardiac troponin levels below conventional detection and is improved by use of N-terminal pro-B-type natriuretic peptide', European Journal of Preventive Cardiology, vol. 21, no. 10, pp. 1275-1284. https://doi.org/10.1177/2047487313492099

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title = "Risk stratification in stable coronary artery disease is possible at cardiac troponin levels below conventional detection and is improved by use of N-terminal pro-B-type natriuretic peptide",

abstract = "AIMS: Low prevalence of detectable cardiac troponin in healthy people and low-risk patients previously curtailed its use. With a new high-sensitive cardiac troponin assay (hs-cTnT), concentrations below conventional detection may have prognostic value, notably in combination with N-terminal pro-B-type natriuretic peptide (NT-pro-BNP).METHODS AND RESULTS: Biomarker concentrations were determined from serum obtained at enrolment in the CLARICOR trial involving 4197 patients with stable coronary artery disease (CAD) followed for 2.6 years. Serum hs-cTnT was detectable (above 3 ng/l) in 78% and above the conventional 99th percentile (13.5 ng/l) in 23%. Across all levels of hs-cTnT there was a graded increase in the risk of cardiovascular death after adjustment for known prognostic indicators: hazard ratio (HR) per unit increase in the natural logarithm of the hs-cTnT level, 1.49; 95% confidence interval (CI), 1.23-1.81; similarly for all-cause mortality (HR 1.48, 95% CI 1.29-1.70) and myocardial infarction (HR 1.37, 95% CI 1.13-1.67). Increasing values of hs-cTnT were associated with increased mortality across all values of NT-pro-BNP, but this was particularly prominent when NT-pro-BNP >400 ng/l.CONCLUSIONS: In patients with stable CAD, any detectable hs-cTnT level is significantly associated with all-cause mortality, cardiovascular death, and myocardial infarction after adjustment for traditional risk factors and NT-pro-BNP. Excess mortality is particularly pronounced in patients with NT-pro-BNP >400 ng/l.",

author = "Stig Lyngb{\ae}k and Per Winkel and G{\o}tze, {Jens P} and Jens Kastrup and Christian Gluud and Kolmos, {Hans J{\o}rn} and Erik Kj{\o}ller and Jensen, {Gorm Boje} and Hansen, {J{\o}rgen Fischer} and Per Hildebrandt and J{\o}rgen Hilden and {CLARICOR Trial Group}",

note = "{\textcopyright} The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.",

year = "2014",

month = oct,

day = "1",

doi = "10.1177/2047487313492099",

language = "English",

volume = "21",

pages = "1275--1284",

journal = "European Journal of Preventive Cardiology",

issn = "2047-4873",

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TY - JOUR

T1 - Risk stratification in stable coronary artery disease is possible at cardiac troponin levels below conventional detection and is improved by use of N-terminal pro-B-type natriuretic peptide

AU - Lyngbæk, Stig

AU - Winkel, Per

AU - Gøtze, Jens P

AU - Kastrup, Jens

AU - Gluud, Christian

AU - Kolmos, Hans Jørn

AU - Kjøller, Erik

AU - Jensen, Gorm Boje

AU - Hansen, Jørgen Fischer

AU - Hildebrandt, Per

AU - Hilden, Jørgen

AU - CLARICOR Trial Group

PY - 2014/10/1

Y1 - 2014/10/1

N2 - AIMS: Low prevalence of detectable cardiac troponin in healthy people and low-risk patients previously curtailed its use. With a new high-sensitive cardiac troponin assay (hs-cTnT), concentrations below conventional detection may have prognostic value, notably in combination with N-terminal pro-B-type natriuretic peptide (NT-pro-BNP).METHODS AND RESULTS: Biomarker concentrations were determined from serum obtained at enrolment in the CLARICOR trial involving 4197 patients with stable coronary artery disease (CAD) followed for 2.6 years. Serum hs-cTnT was detectable (above 3 ng/l) in 78% and above the conventional 99th percentile (13.5 ng/l) in 23%. Across all levels of hs-cTnT there was a graded increase in the risk of cardiovascular death after adjustment for known prognostic indicators: hazard ratio (HR) per unit increase in the natural logarithm of the hs-cTnT level, 1.49; 95% confidence interval (CI), 1.23-1.81; similarly for all-cause mortality (HR 1.48, 95% CI 1.29-1.70) and myocardial infarction (HR 1.37, 95% CI 1.13-1.67). Increasing values of hs-cTnT were associated with increased mortality across all values of NT-pro-BNP, but this was particularly prominent when NT-pro-BNP >400 ng/l.CONCLUSIONS: In patients with stable CAD, any detectable hs-cTnT level is significantly associated with all-cause mortality, cardiovascular death, and myocardial infarction after adjustment for traditional risk factors and NT-pro-BNP. Excess mortality is particularly pronounced in patients with NT-pro-BNP >400 ng/l.

AB - AIMS: Low prevalence of detectable cardiac troponin in healthy people and low-risk patients previously curtailed its use. With a new high-sensitive cardiac troponin assay (hs-cTnT), concentrations below conventional detection may have prognostic value, notably in combination with N-terminal pro-B-type natriuretic peptide (NT-pro-BNP).METHODS AND RESULTS: Biomarker concentrations were determined from serum obtained at enrolment in the CLARICOR trial involving 4197 patients with stable coronary artery disease (CAD) followed for 2.6 years. Serum hs-cTnT was detectable (above 3 ng/l) in 78% and above the conventional 99th percentile (13.5 ng/l) in 23%. Across all levels of hs-cTnT there was a graded increase in the risk of cardiovascular death after adjustment for known prognostic indicators: hazard ratio (HR) per unit increase in the natural logarithm of the hs-cTnT level, 1.49; 95% confidence interval (CI), 1.23-1.81; similarly for all-cause mortality (HR 1.48, 95% CI 1.29-1.70) and myocardial infarction (HR 1.37, 95% CI 1.13-1.67). Increasing values of hs-cTnT were associated with increased mortality across all values of NT-pro-BNP, but this was particularly prominent when NT-pro-BNP >400 ng/l.CONCLUSIONS: In patients with stable CAD, any detectable hs-cTnT level is significantly associated with all-cause mortality, cardiovascular death, and myocardial infarction after adjustment for traditional risk factors and NT-pro-BNP. Excess mortality is particularly pronounced in patients with NT-pro-BNP >400 ng/l.

U2 - 10.1177/2047487313492099

DO - 10.1177/2047487313492099

M3 - Journal article

C2 - 23723326

SN - 2047-4873

VL - 21

SP - 1275

EP - 1284

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

IS - 10

ER -

Risk stratification in stable coronary artery disease is possible at cardiac troponin levels below conventional detection and is improved by use of N-terminal pro-B-type natriuretic peptide

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