title: Prognostic effect of high-sensitive troponin T assessment in elderly patients with chronic heart failure: results from the CORONA trial.
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.
  
  
  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.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00206310.
authors.affiliation: Department of Cardiology.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Gravning
authors.forename: Erik T
authors.initials: ET
authors.lastname: Askevold
authors.forename: Ståle H
authors.initials: SH
authors.lastname: Nymo
authors.forename: Thor
authors.initials: T
authors.lastname: Ueland
authors.forename: John
authors.initials: J
authors.lastname: Wikstrand
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Pål
authors.initials: P
authors.lastname: Aukrust
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.forename: John
authors.initials: J
authors.lastname: Kjekshus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002908:Chronic Disease; D005260:Female; D005464:Fluorobenzenes / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011743:Pyrimidines / Q000627:therapeutic use*; D012307:Risk Factors; D000068718:Rosuvastatin Calcium; D012680:Sensitivity and Specificity; D020521:Stroke / Q000453:epidemiology*; D013449:Sulfonamides / Q000627:therapeutic use*; D015996:Survival Rate; D020107:Troponin T / Q000097:blood*
chemical_list: D000924:Anticholesteremic Agents; D015415:Biomarkers; D005464:Fluorobenzenes; D010446:Peptide Fragments; D011743:Pyrimidines; D013449:Sulfonamides; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D000068718:Rosuvastatin Calcium; D002097:C-Reactive Protein
keywords: heart failure; prognosis; risk assessment; troponin T