Troponin and Cardiac Events in Stable Ischemic Heart Disease and Diabetes

被引:211
作者
Everett, Brendan M. [1 ,2 ,3 ]
Brooks, Maria Mori [4 ,5 ]
Vlachos, Helen E. A. [4 ,5 ]
Chaitman, Bernard R. [6 ]
Frye, Robert L. [7 ]
Bhatt, Deepak L. [1 ]
机构
[1] Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA
[2] Brigham & Womens Hosp, Div Prevent Med, Boston, MA 02115 USA
[3] Harvard Univ, Sch Med, Boston, MA USA
[4] Univ Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15261 USA
[5] Univ Pittsburgh, Grad Sch Publ Hlth, Pittsburgh, PA 15261 USA
[6] St Louis Univ, Ctr Cardiovasc Care, Sch Med, St Louis, MO 63103 USA
[7] Mayo Clin, Dept Med, Div Cardiovasc Dis, Rochester, MN USA
基金
美国国家卫生研究院;
关键词
HIGHLY SENSITIVE ASSAY; MYOCARDIAL-INFARCTION; UNSTABLE ANGINA; EARLY-DIAGNOSIS; T ASSAY; ASSOCIATION; RISK; ELEVATIONS; MANAGEMENT; MORTALITY;
D O I
10.1056/NEJMoa1415921
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Cardiac troponin concentrations are used to identify patients who would benefit from urgent revascularization for acute coronary syndromes. We hypothesized that they might be used in patients with stable ischemic heart disease to identify those at high risk for cardiovascular events who might also benefit from prompt coronary revascularization. METHODS We measured the cardiac troponin T concentration at baseline with a high-sensitivity assay in 2285 patients who had both type 2 diabetes and stable ischemic heart disease and were enrolled in the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes trial. We tested for an association between the troponin T concentration and a composite end point of death from cardiovascular causes, myocardial infarction, or stroke; we then evaluated whether random assignment to prompt revascularization reduced the rate of the composite end point in patients with an abnormal troponin T concentration (>= 14 ng per liter) as compared with those with a normal troponin T concentration (<14 ng per liter). RESULTS Of the 2285 patients, 2277 (99.6%) had detectable (>= 3 ng per liter) troponin T concentrations and 897 (39.3%) had abnormal troponin T concentrations at baseline. The 5-year rate of the composite end point was 27.1% among the patients who had had abnormal troponin T concentrations at baseline, as compared with 12.9% among those who had had normal baseline troponin T concentrations. In models that were adjusted for cardiovascular risk factors, severity of diabetes, electrocardiographic abnormalities, and coronary anatomy, the hazard ratio for the composite end point among patients with abnormal troponin T concentrations was 1.85 (95% confidence interval [CI], 1.48 to 2.32; P<0.001). Among patients with abnormal troponin T concentrations, random assignment to prompt revascularization, as compared with medical therapy alone, did not result in a significant reduction in the rate of the composite end point (hazard ratio, 0.96; 95% CI, 0.74 to 1.25). CONCLUSIONS The cardiac troponin T concentration was an independent predictor of death from cardiovascular causes, myocardial infarction, or stroke in patients who had both type 2 diabetes and stable ischemic heart disease. An abnormal troponin T value of 14 ng per liter or higher did not identify a subgroup of patients who benefited from random assignment to prompt coronary revascularization. (Funded by the National Institutes of Health and Roche Diagnostics; BARI 2D ClinicalTrials.gov number, NCT00006305.)
引用
收藏
页码:610 / 620
页数:11
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