title: Risk stratification in stable coronary artery disease is possible at cardiac troponin levels below conventional detection and is improved by use of N-terminal pro-B-type natriuretic peptide.
abstract: OBJECTIVE
  Low prevalence of detectable cardiac troponin in healthy people and low-risk patients previously curtailed its use. With a new high-sensitive cardiac troponin assay (hs-cTnT), concentrations below conventional detection may have prognostic value, notably in combination with N-terminal pro-B-type natriuretic peptide (NT-pro-BNP).
  
  
  RESULTS
  Biomarker concentrations were determined from serum obtained at enrolment in the CLARICOR trial involving 4197 patients with stable coronary artery disease (CAD) followed for 2.6 years. Serum hs-cTnT was detectable (above 3 ng/l) in 78% and above the conventional 99th percentile (13.5 ng/l) in 23%. Across all levels of hs-cTnT there was a graded increase in the risk of cardiovascular death after adjustment for known prognostic indicators: hazard ratio (HR) per unit increase in the natural logarithm of the hs-cTnT level, 1.49; 95% confidence interval (CI), 1.23-1.81; similarly for all-cause mortality (HR 1.48, 95% CI 1.29-1.70) and myocardial infarction (HR 1.37, 95% CI 1.13-1.67). Increasing values of hs-cTnT were associated with increased mortality across all values of NT-pro-BNP, but this was particularly prominent when NT-pro-BNP >400 ng/l.
  
  
  CONCLUSIONS
  In patients with stable CAD, any detectable hs-cTnT level is significantly associated with all-cause mortality, cardiovascular death, and myocardial infarction after adjustment for traditional risk factors and NT-pro-BNP. Excess mortality is particularly pronounced in patients with NT-pro-BNP >400 ng/l.
authors.affiliation: Copenhagen University Hospital, Glostrup, Denmark stiglyngbaek@gmail.com.
authors.forename: Stig
authors.initials: S
authors.lastname: Lyngbæk
authors.affiliation: Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Winkel
authors.affiliation: Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Jens P
authors.initials: JP
authors.lastname: Gøtze
authors.affiliation: Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Kastrup
authors.affiliation: Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Gluud
authors.affiliation: Odense University Hospital, Odense, Denmark.
authors.forename: Hans Jørn
authors.initials: HJ
authors.lastname: Kolmos
authors.affiliation: Copenhagen University Hospital, Herlev, Denmark.
authors.forename: Erik
authors.initials: E
authors.lastname: Kjøller
authors.affiliation: Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Gorm Boje
authors.initials: GB
authors.lastname: Jensen
authors.affiliation: University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jørgen Fischer
authors.initials: JF
authors.lastname: Hansen
authors.affiliation: Copenhagen University Hospital, Glostrup, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Hildebrandt
authors.affiliation: University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Hilden
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Cardiovascular death; NT-pro-BNP; high-sensitivity troponin T assay; risk prediction; stable coronary artery disease