title: High-Sensitivity Troponin I in Stable Patients with Atherosclerotic Disease in the TRA 2°P - TIMI 50 Trial.
abstract: BACKGROUND
  Cardiac troponin I, measured with a high-sensitivity assay (hs-TnI), is well-established for risk prediction in acute coronary syndromes. However, its prognostic role in stable atherosclerotic disease, particularly for future myocardial infarction (MI), is less well defined.
  
  
  METHODS
  We measured hs-TnI (Abbott ARCHITECT) in 15833 patients with prior MI, ischemic stroke, or peripheral arterial disease from the placebo-controlled Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events (TRA 2°P)-Thrombolysis in Myocardial Infarction (TIMI) 50 trial of the platelet inhibitor vorapaxar, excluding patients with recent MI (<30 days). hs-TnI was categorized into 5 groups based on the detection limit (1.9 ng/L), 99th percentile reference limit (26 ng/L), and tertiles in between (1.9-26 ng/L), as well as sex-specific reference limits.
  
  
  RESULTS
  Higher hs-TnI concentration was associated with older age, male sex, and increased atherosclerosis burden. hs-TnI identified a graded 3-year risk of cardiovascular death, MI, or stroke from 5.0% to 18.6% (P < 0.001), driven by cardiovascular death and MI (P < 0.001). This risk was independent of established clinical risk indicators, B-type natriuretic peptide and C-reactive protein [adjusted hazard ratio 2.70 (95% CI, 1.96-3.71), P < 0.001 for hs-TnI >26 ng/L vs <1.9 ng/L]. In patients with prior MI, there was a pattern of greater absolute benefit with vorapaxar in patients with an increased hs-TnI (absolute risk difference 1.9% with hs-TnI >26 ng/L vs 0.3% with hs-TnI <1.9 ng/L; P interaction = 0.82).
  
  
  CONCLUSIONS
  In stable patients with established atherosclerosis, hs-TnI concentrations effectively stratified the risk of new or recurrent cardiovascular (CV) events, in particular CV death and MI. High-risk patients with prior MI identified by increased hs-TnI had a substantial absolute improvement in net clinical outcome with vorapaxar.
authors.affiliation: Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Alon
authors.initials: A
authors.lastname: Eisen
authors.affiliation: Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Marc P
authors.initials: MP
authors.lastname: Bonaca
authors.affiliation: Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Petr
authors.initials: P
authors.lastname: Jarolim
authors.affiliation: Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Scirica
authors.affiliation: Auckland City Hospital, Auckland, New Zealand.
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.affiliation: Medical University of Silesia, Katowice, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Tendera
authors.affiliation: University of Gothenburg and Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Dellborg
authors.affiliation: University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Nicolau
authors.affiliation: Santo André's Hospital, Leiria, Portugal.
authors.forename: Joao
authors.initials: J
authors.lastname: Morais
authors.affiliation: University of Edinburgh, Edinburgh, UK.
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.affiliation: Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Erin A
authors.initials: EA
authors.lastname: Bohula
authors.affiliation: Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Sabina A
authors.initials: SA
authors.lastname: Murphy
authors.affiliation: Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
authors.affiliation: Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, MA; dmorrow@partners.org.
authors.forename: David A
authors.initials: DA
authors.lastname: Morrow
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007783:Lactones / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D011725:Pyridines / Q000627:therapeutic use; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D007783:Lactones; D011725:Pyridines; D019210:Troponin I; C530299:vorapaxar