title: Prognostic Value of High-Sensitivity Cardiac Troponin T Compared with Risk Scores in Stable Cardiovascular Disease.
abstract: BACKGROUND
  Risk stratification of patients with cardiovascular disease remains challenging despite consideration of risk scores.
  
  
  METHODS
  We aimed to evaluate the prognostic performance of high-sensitivity cardiac troponin T in a low-risk outpatient population presenting for nonsecondary and secondary prevention. All-cause mortality, a composite of all-cause mortality, acute myocardial infarction, and stroke (end point 2), and a composite of all-cause mortality, acute myocardial infarction, stroke and rehospitalization for acute coronary syndrome, and decompensated heart failure (end point 3) were defined. The prognostic performance of high-sensitivity cardiac troponin T on index visit was compared with the PROCAM score and 3 FRAMINGHAM subscores.
  
  
  RESULTS
  In 693 patients with a median follow-up of 796 days, we observed 16 deaths, 32 patients with end point 2, and 83 patients with end point 3. All risk scores performed better in the prediction of all-cause mortality in nonsecondary prevention (area under the curve [AUC]: PROCAM: 0.922 vs 0.523, P = .001, consistent for all other scores). In secondary prevention, high-sensitivity cardiac troponin T outperformed all risk scores in the prediction of all-cause mortality (ΔAUC: PROCAM: 0.319, P <.001, consistent for all other scores) and performed superiorly in the prediction of end point 2 compared with the PROCAM, FRAMINGHAM-Coronary Heart Disease, and FRAMINGHAM-Hard Coronary Heart Disease scores (ΔAUC: PROCAM: 0.176, P = .047, consistent for FRAMINGHAM-Coronary Heart Disease and FRAMINGHAM-Hard Coronary Heart Disease). In nonsecondary prevention, we observed a comparable prognostic performance of high-sensitivity cardiac troponin T and multivariable risk scores. Our findings on the prediction of all-cause mortality compared with the FRAMINGHAM-Hard Coronary Heart Disease score were confirmed in an independent validation cohort on 2046 patients.
  
  
  CONCLUSIONS
  High-sensitivity troponin T provides excellent risk stratification regarding all-cause mortality and all-cause mortality, acute myocardial infarction, and stroke in a secondary prevention cohort in whom risk scores perform poorly.
authors.affiliation: Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum, Heidelberg, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Biener
authors.affiliation: Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum, Heidelberg, Germany. Electronic address: evangelos_giannitsis@med.uni-heidelberg.de.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.affiliation: Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum, Heidelberg, Germany.
authors.forename: Manuel
authors.initials: M
authors.lastname: Kuhner
authors.affiliation: Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zelniker
authors.affiliation: Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum, Heidelberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Mueller-Hennessen
authors.affiliation: Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum, Heidelberg, Germany.
authors.forename: Mehrshad
authors.initials: M
authors.lastname: Vafaie
authors.affiliation: Universitäts-Herzzentrum Freiburg · Bad Krozingen, Klinik für Kardiologie und Angiologie II, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Trenk
authors.affiliation: Universitäts-Herzzentrum Freiburg · Bad Krozingen, Klinik für Kardiologie und Angiologie II, Germany.
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.affiliation: Universitäts-Herzzentrum Freiburg · Bad Krozingen, Klinik für Kardiologie und Angiologie II, Germany.
authors.forename: Willibald
authors.initials: W
authors.lastname: Hochholzer
authors.affiliation: Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum, Heidelberg, Germany.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D055502:Secondary Prevention; D012680:Sensitivity and Specificity; D020521:Stroke / Q000517:prevention & control; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: Cardiovascular disease; Disease progression; High-sensitivity troponin T; Risk scores; Risk stratification