Circulating Troponin As Measured by a Sensitive Assay for Cardiovascular Risk Assessment in Primary Prevention

被引:33
作者
Leistner, David M. [1 ]
Klotsche, Jens [2 ]
Pieper, Lars [2 ]
Stalla, Guenter K. [3 ]
Lehnert, Hendrik [4 ]
Silber, Sigmund [5 ]
Maerz, Winfried [6 ,7 ,8 ,9 ]
Wittchen, Hans-Ulrich [2 ]
Zeiher, Andreas M. [1 ]
机构
[1] Goethe Univ Frankfurt, Dept Med 3, D-60590 Frankfurt, Germany
[2] Tech Univ Dresden, Inst Clin Psychol & Psychotherapy, Dresden, Germany
[3] Max Planck Inst Psychiat, D-80804 Munich, Germany
[4] Univ Schleswig Holstein, Dept Med 1, Lubeck, Germany
[5] Cardiol Practice & Hosp, Munich, Germany
[6] Synlab Ctr Bad Nauheim, Bad Nauheim, Germany
[7] Univ Heidelberg, Mannheim Inst Publ Hlth,Social & Prevent Med, Med Fac Mannheim, D-6900 Heidelberg, Germany
[8] Inst Clin Med, Graz, Austria
[9] Chem Lab Diagnost, Graz, Austria
关键词
ACUTE MYOCARDIAL-INFARCTION; CORONARY-HEART-DISEASE; EARLY-DIAGNOSIS; NONPARAMETRIC APPROACH; ATHEROSCLEROSIS RISK; GENERAL-POPULATION; SURVIVAL ANALYSIS; I ASSAY; T ASSAY; MORTALITY;
D O I
10.1373/clinchem.2011.174292
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
BACKGROUND: Measuring circulating cardiac troponin using novel sensitive assays has revealed that even minute elevations are associated with increased mortality in patients with coronary artery disease or even in the general population. Less well defined, however, is the incremental value of measuring circulating cardiac troponin I (cTnI) by a sensitive assay for risk assessment in primary prevention. METHODS: We measured circulating concentrations of cTnI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hsCRP) in 5388 individuals free of known cardiovascular disease recruited into the DETECT study, a prospective longitudinal population-based cohort study. We determined the prognostic implications for incident major adverse cardiovascular events (MACE) during 5 years of follow-up. RESULTS: Circulating cTnI was detectable in 19% of the subjects. Increased cTnI concentrations were associated with established risk factors for atherosclerosis and demonstrated a graded relationship with all-cause mortality and incident MACE during 5-year follow-up. A single measurement of cTnI significantly improved risk prediction over established risk factors, and also added prognostic information, when adjusted for serum concentrations of NT-proBNP and hsCRP. CONCLUSIONS: Minute increases in cTnI are associated with increased mortality and incident MACE in a large primary prevention cohort and, thus, identify contributors to cardiovascular risk not fully captured by traditional risk factor assessment. (C) 2011 American Association for Clinical Chemistry
引用
收藏
页码:200 / 208
页数:9
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