title: Usefulness of Highly Sensitive Troponin as a Predictor of Short-Term Outcome in Patients With Diabetes Mellitus and Stable Coronary Artery Disease (from the ARTEMIS Study).
abstract: The aim of this study was to test the hypothesis that novel biomarkers may predict cardiac events in diabetic patients with stable coronary artery disease (CAD). Serum levels of highly sensitive troponin T (hs-TnT), B-type natriuretic peptide, highly sensitive C-reactive protein (hs-CRP), galectin-3, and soluble suppressor of tumorigenicity-2 (sST2) were analyzed in 1,137 patients with CAD and with type 2 diabetes, impaired glucose tolerance, or fasting glycaemia (diabetic group) and in 649 patients with normal glucose state. Cardiac death or hospitalization for congestive heart failure was the major end point during the follow-up of 2 years. Forty patients in the diabetic group (3.5%) and 9 patients in the nondiabetic group (1.4%) reached the primary end point. High hs-TnT level (≥14 ng/l) was the strongest predictor of the primary end point with hazard ratio of 24.5 (95% confidence interval 8.7 to 69.0; p <0.001) and remained so when adjusted for clinical variables, ejection fraction, renal, lipid, and glycemic status and other biomarkers (hazard ratio 9.9, 95% confidence interval 3.2 to 30.8; p <0.001). In the multivariate model, hs-CRP, B-type natriuretic peptide, and sST2 also predicted the primary end point in the diabetic group (p <0.01 for all). Only sST2 (p <0.001) and hs-CRP (p = 0.02) predicted the primary end point in nondiabetic group. The inclusion of hs-TnT in the model significantly improved discrimination (integrated discrimination improvement 0.050) and reclassification of the patients (net reclassification index 0.21). In conclusion, hs-TnT is a strong predictor of cardiac death or hospitalization for heart failure independently from traditional risk markers or other biomarkers in diabetic patients with stable CAD.
authors.affiliation: Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland. Electronic address: samuli.lepojarvi@ppshp.fi.
authors.forename: E Samuli
authors.initials: ES
authors.lastname: Lepojärvi
authors.affiliation: Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
authors.forename: Olli-Pekka
authors.initials: OP
authors.lastname: Piira
authors.affiliation: Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
authors.forename: Antti M
authors.initials: AM
authors.lastname: Kiviniemi
authors.affiliation: Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
authors.forename: Johanna A
authors.initials: JA
authors.lastname: Miettinen
authors.affiliation: Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Kenttä
authors.affiliation: Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
authors.forename: Olavi
authors.initials: O
authors.lastname: Ukkola
authors.affiliation: Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Tulppo
authors.affiliation: Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
authors.forename: Heikki V
authors.initials: HV
authors.lastname: Huikuri
authors.affiliation: Department of Internal Medicine and Clinical Chemistry, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
authors.forename: M Juhani
authors.initials: MJ
authors.lastname: Junttila
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death / Q000639:trends; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000382:microbiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D014336:Troponin