Six-Year Change in High-Sensitivity Cardiac Troponin T and Risk of Subsequent Coronary Heart Disease, Heart Failure, and Death
Six-Year Change in High-Sensitivity Cardiac Troponin T and Risk of Subsequent Coronary Heart Disease, Heart Failure, and Death
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DOI：
10.1001/jamacardio.2016.0765
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发表时间：
2016-08-01
期刊：
影响因子：
24
通讯作者：
Selvin, Elizabeth
中科院分区：
文献类型：
--
作者：
McEvoy, John W.;Chen, Yuan;Selvin, Elizabeth
高敏感性心肌肌钙蛋白T（hs-cTnT）是心血管风险的生物标志物，很快将在美国获得临床应用的批准。然而，将hs-cTnT的长期时间变化与结果联系起来的数据是有限的，特别是在初级预防settings. ObjectiveTo检查hs-cTnT的6年变化与冠心病（CHD）、心力衰竭（HF）和全因死亡率的关系。2011年，纳入了来自社区动脉粥样硬化风险研究的8838名混血参与者，他们最初没有CHD和HF，并且间隔6年测量了两次hs-cTnT。数据分析时间为2014年10月28日至2016年3月9日。主要结果和指标收集危险因素和时间性hs-cTnT数据。使用考克斯比例风险回归，我们研究了hs-cTnT变化与随后的CHD、HF和死亡的相关性，最长时间为16年。结果在8838名参与者中（平均年龄56岁; 5215名女性[59.0%]; 1891名黑人[21.4%]），共有1157例CHD事件，965例HF事件和1813例死亡。事件可检测hs-cTnT（基线，< 0.005 ng/mL;随访，>= 0.005 ng/mL）与随后的CHD独立相关（风险比[HR]，1.4; 95% CI，1.2-1.6），HF（HR，2.0; 95% CI，1.6-2.4）和死亡（HR，1.5; 95% CI，1.3-1.7），相对于两次访视时hs-cTnT水平低于0.005 ng/mL。此外，在hs-cTnT升高最显著的个体中（例如，基线，< 0.005 ng/mL;随访，>= 0.014 ng/mL），CHD和死亡的HR高达4，HF的HR高达8。hs-cTnT相对基线降低大于50%的患者，后续结局的风险较低。此外，当将hs-cTnT变化的信息添加到包括传统风险因素、N末端脑钠肽前体和基线hs-cTnT水平的模型中时，可改善对HF和死亡的区分。在裁定HF住院的个人，hs-cTnT的变化似乎是类似的HF与减少和保存射血fractions.CONCLUSIONS和RELEVANCE临时增加hs-cTnT，提示进行性心肌损伤，是独立相关的事件CHD，死亡，最重要的是，HF。hs-cTnT轨迹的连续测定为基线检测增加了临床相关信息，可能有助于预后评估和针对高风险个体的预防策略，尤其是A期或B期HF患者。
IMPORTANCE High-sensitivity cardiac troponin T (hs-cTnT) is a biomarker of cardiovascular risk and could be approved in the United States for clinical use soon. However, data linking long-term temporal change in hs-cTnT to outcomes are limited, particularly in primary prevention settings.OBJECTIVE To examine the association of 6-year change in hs-cTnT with incident coronary heart disease (CHD), heart failure (HF), and all-cause mortality.DESIGN, SETTING, AND PARTICIPANTS This prospective observational cohort study, performed from January 1, 1990, to December 31, 2011, included 8838 participants with biracial representation from the Atherosclerosis Risk in Communities Study who were initially free of CHD and HF and who had hs-cTnT measured twice, 6 years apart. Data analysis was performed from October 28, 2014, to March 9, 2016.MAIN OUTCOME AND MEASURES Risk factor and temporal hs-cTnT datawere collected. Using Cox proportional hazards regression, we examined the association of hs-cTnT change with subsequent CHD, HF, and death during a maximum of 16 years. Improvement in discrimination was determined by the Harrell C statistic.RESULTS Of the 8838 participants (mean age, 56 years; 5215 female [59.0%]; 1891 black [21.4%]) there were 1157 CHD events, 965 HF events, and 1813 deaths overall. Incident detectable hs-cTnT (baseline, < 0.005 ng/mL; follow-up, >= 0.005 ng/mL) was independently associated with subsequent CHD (hazard ratio [HR], 1.4; 95% CI, 1.2-1.6), HF (HR, 2.0; 95% CI, 1.6-2.4), and death (HR, 1.5; 95% CI, 1.3-1.7), relative to an hs-cTnT level less than 0.005 ng/mL at both visits. In addition, HRs as high as 4 for CHD and death and 8 for HF were recorded among individuals with the most marked hs-cTnT increases (eg, baseline, < 0.005 ng/mL; follow-up, >= 0.014 ng/mL). Risk for subsequent outcomes was lower among those with relative hs-cTnT reductions greater than 50% from baseline. Furthermore, information on hs-cTnT change improved discrimination for HF and death when added to a model that included traditional risk factors, N-terminal pro-brain natriuretic peptide, and baseline hs-cTnT level. Among individuals with adjudicated HF hospitalizations, hs-cTnT change appeared to be similarly associated with HF with reduced and preserved ejection fraction.CONCLUSIONS AND RELEVANCE Temporal increases in hs-cTnT, suggestive of progressive myocardial damage, are independently associated with incident CHD, death, and, above all, HF. Serial determination of hs-cTnT trajectory adds clinically relevant information to baseline testing and may be useful in prognostic assessments and the targeting of prevention strategies to high-risk individuals, especially among persons with stage A or B HF.