Combined Assessment of High-Sensitivity Troponin T and Noninvasive Coronary Plaque Composition for the Prediction of Cardiac Outcomes.
OBJECTIVE
To determine the risk-stratification ability of plaque volume and composition assessment with cardiac computed tomographic (CT) angiography and high-sensitivity troponin T (hsTnT) in patients at intermediate risk for coronary artery disease (CAD).


METHODS
The study complied with the Declaration of Helsinki and was approved by the local ethics committee. All patients gave written informed consent. Five hundred twenty-one consecutive patients (mean age ± standard deviation, 62 years ± 10; 256 men and 265 women) were included in this prospective, observational, longitudinal, single-center study. Quantitative cardiac CT angiography analysis was performed in all patients (for 7690 coronary segments), whereas biomarkers (hsTnT and high-sensitivity C-reactive protein) were available in 408 patients (78%). To evaluate the incremental value of cardiac CT angiography and hsTnT for the prediction of cardiovascular events, multivariate Cox regression and integrated discrimination improvement analysis were applied.


RESULTS
In 521 patients, 13 hard cardiac events occurred during a mean follow-up period of 2.3 years ± 1.1 (median, 2.4 years; range, 0.5-4.5 years), while 23 patients underwent late coronary revascularization. The Duke clinical score was 51% ± 30, indicating intermediate risk. The presence of no plaques or purely calcified versus noncalcified plaques, plaque volume according to tertiles, and increased hsTnT (≥14 pg/mL) was independently associated with hard cardiac events (hazard ratio [HR] = 26.08, 95% confidence interval [CI]: 2.78, 244.99; HR = 12.14, 95% CI: 1.87, 78.74; and HR = 10.31, 95% CI: 2.72, 39.0, respectively; P < .01 for all). Patients with increased hsTnT and plaque burden (n = 53) showed the highest incidence for hard cardiac events (annual rate, 12.7%), followed by those with either increased hsTnT or plaque burden (n = 145; annual rate = 0.44%, P < .03), while those with lower hsTnT and plaque burden exhibited excellent outcomes and no hard event during the follow-up duration (n = 210; annual rate = 0%, P < .001).


CONCLUSIONS
Use of hsTnT as a marker of myocardial microinjury and cardiac CT angiography as a marker of the total atherosclerotic burden improves the prediction of cardiac outcome in patients with presumably stable CAD and may aid in personalized risk stratification in patients at intermediate risk.
From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Gitsios
G
Gitsioudis
From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Alena
A
Schüssler
From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Eszter
E
Nagy
From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Pál
P
Maurovich-Horvat
From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Sebastian J
SJ
Buss
From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Andreas
A
Voss
From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Waldemar
W
Hosch
From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Nina
N
Hofmann
From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Hans-Ulrich
HU
Kauczor
From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Evangelos
E
Giannitsis
From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Hugo A
HA
Katus
From the Department of Cardiology (G.G., A.S., E.N., S.J.B., N.H., E.G., H.A.K., G.K.), Institute of Psychology (A.V.), and Department of Diagnostic and Interventional Radiology (W.H., H.U.K.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany; and MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (E.N., P.M.H.).
Grigorios
G
Korosoglou
D057791:Cardiac Imaging Techniques; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D020107:Troponin T / Q000097:blood*
D020107:Troponin T