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High-sensitivity cardiac troponin i predicts long-term cardiovascular outcomes in the west of Scotland coronary prevention study

Session Novel biomarkers in predicting cardiovascular diseases

Speaker Nicholas Mills

Event : ESC Congress 2014

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes: Biomarkers
  • Session type : Rapid Fire Abstracts

Authors : NL Mills (Edinburgh,GB), ASV Shah (Edinburgh,GB), DA Mcallister (Edinburgh,GB), M Robertson (Glasgow,GB), FS Strachan (Edinburgh,GB), M Caslake (Glasgow,GB), DE Newby (Edinburgh,GB), C Packard (Glasgow,GB), I Ford (Glasgow,GB)

Authors:
N.L. Mills1 , A.S.V. Shah2 , D.A. Mcallister2 , M. Robertson3 , F.S. Strachan2 , M. Caslake3 , D.E. Newby2 , C. Packard3 , I. Ford3 , 1Royal Infirmary of Edinburgh - Edinburgh - United Kingdom , 2University of Edinburgh - Edinburgh - United Kingdom , 3University of Glasgow - Glasgow - United Kingdom ,

Citation:
European Heart Journal ( 2014 ) 35 ( Abstract Supplement ), 205

Background: The West of Scotland Coronary Prevention Study compared pravastatin versus placebo in middle-aged men without a history of myocardial infarction. We evaluated the association between baseline troponin concentration and cardiovascular events over 15 years follow-up, and the impact of statin therapy on troponin at 1 year.

Methods: Plasma cardiac troponin I concentration was measured with a high-sensitivity assay (Abbott Diagnostics) at baseline and 1 year following randomisation to 40 mg of pravastatin or placebo in 3,278 participants. Hospitalization for myocardial infarction or death from coronary heart disease was recorded with a median follow up of 15 years.

Results: Troponin concentration at baseline was an independent predictor of myocardial infarction or death from coronary heart disease (p<0.001, Figure). Compared to the first quarter (≤3.1 ng/L), patients in the top quarter (≥5.2 ng/L) were at highest risk after adjustment for other risk factors (Hazard Ratio 1.52, 95% Confidence Interval [CI] 1.15 to 1.99, p=0.003). Troponin concentration at 1 year was reduced in patients on pravastatin (-11.4%, 95%CI -7.4% to -15.2%), but increased in those on placebo (10.5%, 95%CI 5.1% to 16.2%; p<0.001 between groups).

Conclusion: Cardiac troponin I concentration is an independent predictor for cardiovascular events and is reduced by statin therapy. This biomarker has major potential for cardiovascular risk stratification and for use in clinical efficacy or safety trials.

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