TY - JOUR
T1 - High-Sensitivity Troponin I and Coronary Computed Tomography in Symptomatic Outpatients With Suspected CAD
T2 - Insights From the PROMISE Trial
AU - PROMISE Investigators
AU - Januzzi, James L.
AU - Suchindran, Sunil
AU - Coles, Adrian
AU - Ferencik, Maros
AU - Patel, Manesh R.
AU - Hoffmann, Udo
AU - Ginsburg, Geoffrey S.
AU - Douglas, Pamela S.
N1 - Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/6
Y1 - 2019/6
N2 - 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 CAD50 (≥50% stenosis in any vessel)and CAD70 (≥70% stenosis or ≥50% left main). 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 CAD50 (odds ratio: 1.15 per interquartile range; p = 0.02)and CAD70 (odds ratio: 1.25 per interquartile range; p = 0.001). 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.
AB - 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 CAD50 (≥50% stenosis in any vessel)and CAD70 (≥70% stenosis or ≥50% left main). 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 CAD50 (odds ratio: 1.15 per interquartile range; p = 0.02)and CAD70 (odds ratio: 1.25 per interquartile range; p = 0.001). 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.
KW - coronary artery disease
KW - coronary computed tomography angiography
KW - troponin
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U2 - 10.1016/j.jcmg.2018.01.021
DO - 10.1016/j.jcmg.2018.01.021
M3 - Article
C2 - 29550314
AN - SCOPUS:85043514028
SN - 1936-878X
VL - 12
SP - 1047
EP - 1055
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 6
ER -