title: High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort.
abstract: BACKGROUND
  Recent studies have demonstrated the association between increased concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and the incidence of myocardial infarction, heart failure, and mortality. However, most prognostic studies to date focus on the value of hs-cTnT in the elderly or general population. The value of hs-cTnT in symptomatic patients visiting the outpatient department remains unclear. The aim of this study was to investigate the prognostic value of hs-cTnT as a biomarker in patients with symptoms of chest discomfort suspected for coronary artery disease and to assess its additional value in combination with other risk stratification tools in predicting cardiac events.
  
  
  METHODS
  We studied 1,088 patients (follow-up 2.2 ± 0.8 years) with chest discomfort who underwent coronary calcium scoring and coronary CT-angiography. Traditional cardiovascular risk factors and concentrations of hs-cTnT, N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP) were assessed. Study endpoint was the occurrence of late coronary revascularization (>90 days), acute coronary syndrome, and cardiac mortality.
  
  
  RESULTS
  Hs-cTnT was a significant predictor for the composite endpoint (highest quartile [Q4]>6.7 ng/L, HR 3.55; 95%CI 1.88-6.70; P<0.001). Survival analysis showed that hs-cTnT had significant predictive value on top of current risk stratification tools (Chi-square change P<0.01). In patients with hs-cTnT in Q4 versus <Q4, a 2- to 3-fold increase in cardiovascular risk was noticed, either when corrected for high or low Framingham risk score, coronary calcium scoring, or CT-angiography assessment (HR 3.11; 2.73; 2.47; respectively; all P<0.01). This was not the case for hsCRP and NT-proBNP.
  
  
  CONCLUSIONS
  Hs-cTnT is a useful prognostic biomarker in patients with chest discomfort suspected for coronary artery disease. In addition, hs-cTnT was an independent predictor for cardiac events when corrected for cardiovascular risk profiling, calcium score and CT-angiography results.
authors.affiliation: Department of Clinical Chemistry, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Alma M
authors.initials: AM
authors.lastname: Mingels
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Joosen
authors.forename: Mathijs O
authors.initials: MO
authors.lastname: Versteylen
authors.forename: Eduard M
authors.initials: EM
authors.lastname: Laufer
authors.forename: Mark H
authors.initials: MH
authors.lastname: Winkens
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Wildberger
authors.forename: Marja P
authors.initials: MP
authors.lastname: Van Dieijen-Visser
authors.forename: Leonard
authors.initials: L
authors.lastname: Hofstra
mesh_terms: D015415:Biomarkers / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D002637:Chest Pain / Q000175:diagnosis*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D004452:Echocardiography; D023381:Endpoint Determination; D006801:Humans; D053208:Kaplan-Meier Estimate; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D020107:Troponin T / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D002118:Calcium