High-sensitivity troponin can improve risk stratification in cardiovascular diseases

Czech version

Authors: Ján Murín
Authors‘ workplace: I. interná klinika LF UK a UNB, Nemocnica Staré Mesto, Bratislava
Published in: Diab Obez 2022; 22(44): 85-89
Category: Reviews

Overview

In 2018 AHA and ACC Societies published cholesterol management guidelines. They identified two distinct groups of patients with atherosclerotic cardiovascular disease (CVD) with different treatment recommendations. A prospective cohort biomarker substudy (PEGASUS TIMI 54 study) was performed (8 635 patients, subgroup with very high-risk for CVD and another with lower risk for CVD due to mentioned guidelines, but patients were stratified also on the basis of hs-troponin I serum levels using cut points 2 ng/l as limit for detection and 6 ng/l for risk threshold). All patients had myocardial infarction 1 to 3 years before enrollment, were at least 50 years of age and had at least 1 high-risk feature. Primary end-point (EP) was a composite of CV death, myocardial infarction or stroke (study from 2010 October – 2014 December, but analyzed in 2019 June – 2020 January). The median age was 65 years, 76.6% were men. Patients with clinical criteria for very-high risk of CVD had primary EP (3 year event rate) 8.8% compared with 5% in patients with lover-risk of CVD (HR 2.01, S). When patients in the very-high risk CVD were further stratified by hs-TnI levels – 9% of these patients had undetected hs-TnI and their 3 year event rate was only 2.7% (less than the overall rate in the lower risk CVD subgroup). Analogously in the lower-risk subgroup of CVD, 22.6% of patients had hs-TnI > 6 ng/l and their event rate was 9.1% (as was the overall rate in very high-risk subgroup of patients for CVD). From these findings we can say that strategy incorporating hs-TnI into guideline derived CVD risk algorithm is useful.

Keywords:

risk stratification – atherosclerotic cardiovascular disease – guidelines for cholesterol management guidelines – hs-troponin I

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