Original Investigation
Atherosclerotic Cardiovascular Disease Risk Stratification Based on Measurements of Troponin and Coronary Artery Calcium

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Abstract

Background

Low values of high-sensitivity cardiac troponin (hs-cTn) and coronary artery calcium (CAC) scores of zero are associated with a low risk for atherosclerotic cardiovascular disease (ASCVD).

Objectives

The purpose of this study was to evaluate baseline hs-cTnT and CAC in relation to ASCVD.

Methods

Baseline hs-cTnT (limit of detection [LoD] 3 ng/l) and CAC measurements were analyzed across participants age 45 to 84 years without clinical cardiovascular disease from the prospective MESA (Multi-Ethnic Study of Atherosclerosis) in relationship to incident ASCVD.

Results

Among 6,749 participants, 1,002 ASCVD events occurred during a median follow-up of 15 years. Participants with detectable CAC (20.1 vs. 5.0 events per 1,000 person-years; adjusted hazard ratio [HR]: 2.35; 95% confidence interval [CI]: 2.0 to 2.76; p < 0.001) and detectable hs-cTnT (15.4 vs. 5.2 per 1,000 person-years; adjusted HR: 1.47; 95% CI: 1.21 to 1.77; p < 0.001) had higher rates of ASCVD than those with undetectable results. Individuals with undetectable hs-cTnT (32%) had similar risk for ASCVD as did those with a CAC of zero (50%) (5.2 vs. 5.0 per 1,000 person-years). Together, hs-cTnT and CAC (discordance 38%) resulted in the following ASCVD event rates: hs-cTnT < LoD/CAC = 0: 2.8 per 1,000 person-years (reference), hs-cTnT ≥ LoD/CAC = 0: 6.8 per 1,000 person-years (HR: 1.59; 95% CI: 1.17 to 2.16; p = 0.003), hs-cTnT < LoD/CAC > 0: 11.1 per 1,000 person-years (HR: 2.74; 95% CI: 1.96 to 3.83; p < 0.00001), and hs-cTnT ≥ LoD/CAC > 0: 22.6 per 1,000 person-years (HR: 3.50; 95% CI: 2.60 to 4.70; p < 0.00001).

Conclusions

An undetectable hs-cTnT identifies patients with a similar, low risk for ASCVD as those with a CAC score of zero. The increased risk among those with discordant results supports their conjoined use for risk prediction.

Key Words

atherosclerotic cardiovascular disease
coronary artery calcium
high-sensitivity cardiac troponin
primary prevention
risk stratification

Abbreviations and Acronyms

ASCVD
atherosclerotic cardiovascular disease
CAC
coronary artery calcium
CT
computed tomography
cTn
cardiac troponin
HR
hazard ratio
hs-cTn
high-sensitivity cardiac troponin
LoD
limit of detection

Cited by (0)

This research was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences (NCATS). The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services. Dr. Sandoval has served on an Advisory Board/speaker for Abbott Diagnostics; and has served on an Advisory Board for Roche Diagnostics, both without personal financial compensation. Dr. Daniels has served on an Advisory Board for Quidel and Roche; and has served on clinical endpoints adjudication committees for Siemens and Abbott. Dr. DeFilippis has received grant support from the National Institutes of Health, AstraZeneca, and Ionis; and has received consulting income from Radiometer. Dr. deFilippi has received grants/contracts to him through his institution from Abbott Diagnostics, FujiRebio, Ortho Diagnostics, and Roche Diagnostics; has received consulting income from Fuji Rebio, Ortho Diagnostics, Roche Diagnostics, and Siemens Healthineers; and has received royalty income from UpToDate. Dr. Jaffe has consulted or is presently consulting for Beckman, Abbott, Siemens, ET Healthcare, Roche, Quidel, Brava, and Sphingotec; and has served as a consultant for Blade and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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© 2020 by the American College of Cardiology Foundation. Published by Elsevier.