High-sensitivity cardiac troponin I and the diagnosis of coronary artery disease in patients with suspected angina pectoris

Adamson, P. D. et al. (2018) High-sensitivity cardiac troponin I and the diagnosis of coronary artery disease in patients with suspected angina pectoris. Circulation: Cardiovascular Quality and Outcomes, 11(2), e004227. (doi:10.1161/CIRCOUTCOMES.117.004227) (PMID:29444926)

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Abstract

Background: We determined whether high-sensitivity cardiac troponin I can improve the estimation of the pretest probability for obstructive coronary artery disease (CAD) in patients with suspected stable angina. Methods and Results: In a prespecified substudy of the SCOT-HEART trial (Scottish Computed Tomography of the Heart), plasma cardiac troponin was measured using a high-sensitivity single-molecule counting assay in 943 adults with suspected stable angina who had undergone coronary computed tomographic angiography. Rates of obstructive CAD were compared with the pretest probability determined by the CAD Consortium risk model with and without cardiac troponin concentrations. External validation was undertaken in an independent study population from Denmark comprising 487 patients with suspected stable angina. Higher cardiac troponin concentrations were associated with obstructive CAD with a 5-fold increase across quintiles (9%–48%; P<0.001) independent of known cardiovascular risk factors (odds ratio, 1.35; 95% confidence interval, 1.25–1.46 per doubling of troponin). Cardiac troponin concentrations improved the discrimination and calibration of the CAD Consortium model for identifying obstructive CAD (C statistic, 0.788–0.800; P=0.004; χ2=16.8 [P=0.032] to 14.3 [P=0.074]). The updated model also improved classification of the American College of Cardiology/American Heart Association pretest probability risk categories (net reclassification improvement, 0.062; 95% confidence interval, 0.035–0.089). The revised model achieved similar improvements in discrimination and calibration when applied in the external validation cohort. Conclusions: High-sensitivity cardiac troponin I concentration is an independent predictor of obstructive CAD in patients with suspected stable angina. Use of this test may improve the selection of patients for further investigation and treatment. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01149590.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and McAllister, Dr David and Newby, Professor David and Roditi, Dr Giles
Authors: Adamson, P. D., Hunter, A., Madsen, D. M., Shah, A. S.V., McAllister, D. A., Pawade, T. A., Williams, M. C., Berry, C., Boon, N. A., Flather, M., Forbes, J., McLean, S., Roditi, G., Timmis, A. D., van Beek, E. J.R., Dweck, M. R., Mickley, H., Mills, N. L., and Newby, D. E.
College/School:College of Medical Veterinary and Life Sciences
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Circulation: Cardiovascular Quality and Outcomes
Publisher:American Heart Association
ISSN:1941-7713
ISSN (Online):1941-7713
Published Online:14 February 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in Circulation: Cardiovascular Quality and Outcomes 11(2): e004227
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
754451Combining efficacy estimates from clinical trials with the natural history obtained from large routine healthcare databases to determine net overall treatment benefitsDavid McAllisterWellcome Trust (WELLCOTR)201492/Z/16/ZIHW - PUBLIC HEALTH