Prognostic effect of high-sensitive troponin T assessment in elderly patients with chronic heart failure: results from the CORONA trial

Gravning, J., Askevold, E.T., Nymo, S.H., Ueland, T., Wikstrand, J., McMurray, J.J.V. , Aukrust, P., Gullestad, L. and Kjekshus, J. (2014) Prognostic effect of high-sensitive troponin T assessment in elderly patients with chronic heart failure: results from the CORONA trial. Circulation: Heart Failure, 7(1), pp. 96-103. (doi:10.1161/CIRCHEARTFAILURE.113.000450) (PMID:24284025)

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Abstract

Background—The incremental prognostic value of high-sensitive troponin T (hs-cTnT) in heart failure (HF) beyond that of high-sensitivity C-reactive protein and amino-terminal probrain natriuretic peptide is debated. We examined the prognostic value of hs-cTnT in a subgroup of patients from the Controlled Rosuvastatin Multinational Trial in HF (CORONA) study.

Methods and Results—Hs-cTnT as a risk factor for the primary end point (cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke; n=356), as well as all-cause mortality (n=366), cardiovascular mortality (n=299), and the composite of cardiovascular mortality and hospitalization from worsening of HF (n=465), was investigated in 1245 patients (≥60 years; New York Heart Association [NYHA] class II–IV, ischemic systolic HF) randomly assigned to 10 mg rosuvastatin or placebo. In multivariable analyses, adjusting for left ventricular ejection fraction, NYHA class, age, body mass index, diabetes mellitus, sex, intermittent claudication, heart rate, estimated glomerular filtration rate, apolipoprotein B/apolipoprotein A-1 ratio, amino-terminal probrain natriuretic peptide, high-sensitivity C-reactive protein, and hs-cTnT (both dichotomized according to the 99th percentile and as a continuous variable) was associated with all end points (primary end point: hazard ratio, 1.87 and 1.51, respectively, per SD change; P<0.001; all other end points: hazard ratio, 1.39–1.70). However, improved discrimination as assessed by C-statistics was only seen for the primary end point and all-cause mortality.

Conclusions—Elevated hs-cTnT levels provide strong and independent prognostic information in older patients with chronic ischemic HF.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: Gravning, J., Askevold, E.T., Nymo, S.H., Ueland, T., Wikstrand, J., McMurray, J.J.V., Aukrust, P., Gullestad, L., and Kjekshus, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Circulation: Heart Failure
Publisher:Lippincott Williams and Wilkins
ISSN:1941-3289
ISSN (Online):1941-3297

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