Troponin Testing in Patients with Stable Ischemic Heart Disease

August 12, 2015

Troponin Testing in Patients with Stable Ischemic Heart Disease

  1. Harlan M. Krumholz, MD, SM

High-sensitivity troponin T levels may be useful for risk stratification but only if an intervention can be identified.

  1. Harlan M. Krumholz, MD, SM

Cardiac troponin testing is useful in risk-stratifying patients with acute coronary syndromes. To determine if it also might be prognostic for patients with stable ischemic heart disease (IHD), investigators conducted an ancillary study of the BARI 2D trial (NEJM JW Cardiol Jul 2009and N Engl J Med 2009; 360:2503), in which patients with both stable IHD and type 2 diabetes were randomized to percutaneous coronary intervention or coronary artery bypass grafting.

Of 2285 patients, 39% had baseline high-sensitivity troponin T levels that the authors classified as abnormal (≥14 ng/L). At a median follow-up of 5 years, these patients had significantly higher incidence of myocardial infarction, stroke, or death from cardiovascular causes (the composite endpoint) than those with normal levels (27.1% vs. 12.9%; adjusted hazard ratio, 1.85). An increase in high-sensitivity troponin T level of >25% during the first year was also associated with worse outcome. Prompt revascularization for patients with abnormal levels did not improve outcomes.

Comment

These results open the possibility of using high-sensitivity troponin T testing to further risk-stratify stable IHD patients. However, for testing to be of practical use, we would need an intervention that is triggered by the test and, based on decisions emanating from the result, could improve outcomes for patients.

Editor Disclosures at Time of Publication

  • Disclosures for Harlan M. Krumholz, MD, SM at time of publication Consultant / Advisory board United Healthcare; VHA, Inc.; Premier, Inc. Equity ImageCor; Me2Health Grant / Research support FDA; NIH-NHLBI; Commonwealth Fund; The Catherine and Patrick Weldon Donaghue Medical Research Foundation; Robert Wood Johnson Foundation; Medtronic; Johnson and Johnson; Chinese National Center for Cardiovascular Disease; FDA; CMS Editorial boards BMJ.com/US; American Journal of Managed Care; American Journal of Medicine; Archives of Medical Science; Central European Journal of Medicine; Critical Pathways in Cardiology; Current Cardiovascular Risk Reports; JACC: Cardiovascular Imaging; Journal of Cardiovascular Medicine; Circulation: Cardiovascular Quality and Outcomes Leadership positions in professional societies American Board of Internal Medicine (Chair, Assessment 2020 Task Force)

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