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High-sensitive cardiac troponin I is associated with the extent of coronary atherosclerosis and predicts outcome in patients with suspected stable CAD

Session Poster session 1

Speaker Chiara Caselli

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : C Caselli (Pisa,IT), R Liga (Pisa,IT), C Prontera (Pisa,IT), M De Graaf (Leiden,NL), V Lorenzoni (Pisa,IT), R Ragusa (Pisa,IT), S Del Ry (Pisa,IT), G Turchetti (Pisa,IT), D Chiappino (Pisa,IT), SR Underwood (London,GB), J Knuuti (Turku,FI), A Scholte (Leiden,NL), A Clerico (Pisa,IT), D Neglia (Pisa,IT)

Authors:
C. Caselli1 , R. Liga2 , C. Prontera3 , M. De Graaf4 , V. Lorenzoni5 , R. Ragusa5 , S. Del Ry1 , G. Turchetti5 , D. Chiappino3 , S.R. Underwood6 , J. Knuuti7 , A. Scholte4 , A. Clerico5 , D. Neglia3 , 1Institute of Clinical Physiology of CNR, Foundation G. Monasterio - Pisa - Italy , 2Azienda Ospedaliero-Universitaria Pisana - Pisa - Italy , 3Gabriele Monasterio Foundation - Pisa - Italy , 4Leiden University Medical Center - Leiden - Netherlands , 5Sant'Anna School of Advanced Studies - Pisa - Italy , 6Imperial College London - London - United Kingdom , 7Turku University Hospital - Turku - Finland ,

On behalf: EVINCI study

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 193

Background: Cardiac Troponin I, measured with a high-sensitive assay (hs-cTnI), is a well-established biomarker for risk prediction in acute coronary syndromes. However, its role in stable coronary artery disease (CAD) is less well defined.

Purpose: This study was conducted to evaluate the relationship of circulating hs-cTnI concentrations with presence/extent of CAD and cardiovascular events at follow-up.

Methods: Hs-cTnI was measured in 367 patients with suspected stable CAD (mean age 60.5±9, 219 males) as part of the multicenter Evaluation of Integrated Cardiac Imaging (EVINCI) European study. Patients were characterized for clinical risk factors. Coronary computed tomography angiography (CCTA) was performed to assess the presence of significant CAD (>50% stenosis of at least one major coronary vessel). Moreover, an individual CCTA score, expressing the global coronary atherosclerotic burden, was calculated combining extent, severity, composition, and location of plaques. All patients entered a clinical follow-up (1640±320 days). The composite cardiovascular outcome measure included all cause mortality, non fatal myocardial infarction, hospitalization for unstable angina or heart failure, and late coronary revascularization (>90 days after enrollment).

Results: The median value (25–75 percentile) of hs-cTnI was 4.4 (2.4–12.48) ng/L. Circulating hs-cTnI concentrations were progressively increased from patients with normal coronary arteries to patients with non-obstructive or obstructive CAD at CCTA (normals: 35.01±15.4 (mean±SE) ng/L; not obstructive: 47.32±16.2 ng/L; obstructive: 92.59±31.9 ng/L; P=0.0005). At a multivariate analysis including age, gender and cardiovascular risk factors, higher values of hs-cTnI were independently associated with CCTA score (Coefficient 2.27, SE 1.1, P=0.0392). At Cox analysis, either hs-cTnI or CCTA score were independent predictors of cardiovascular events (hs-cTnI: HR 2.09, 95% CI, 1.05–4.13, P=0.0352; CCTA score: HR 1.06, 95% CI, 1.02–1.08. P=0.0004) after correction for age, gender, and clinical risk factors.

Conclusions: In patients with suspected stable CAD, hs-cTnI was associated with the presence and extent of coronary atherosclerosis and could predict adverse cardiovascular outcome, similarly to CCTA risk score and independently of traditional cardiovascular risk factors.

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