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N Engl J Med. 2015 Aug 13;373(7):610-20. doi: 10.1056/NEJMoa1415921.

Troponin and Cardiac Events in Stable Ischemic Heart Disease and Diabetes.

Collaborators (432)

Detre KM, Kelsey SF, Brooks MM, Orchard TJ, Thomas SB, Tyrrell KS, Rana JS, Averbach F, MacGregor JM, O'Neal SM, Pitluga K, Sansing V, Tranchine M, Crow SW, Bertolet MM, Hardison R, Kip K, Lombardero M, Lu J, Janiszewski S, Protivnak D, Reiser S, Barton S, Guo P, Kushner Y, Martin JP, Kania C, Kania M, O'Donnell J, Maxwell RA, Frye RL, Goldberg S, Rosenberg Y, Desvigne-Nickens P, Ershow A, Gordon D, Paltoo D, Jones TL, Hueb W, Ramires J, Lopes N, Wajchenberg BL, Martinez EE, Oliveira SA, Ribeiro EE, Perin M, Betti R, Schwartz L, Steiner G, Barolet A, Groenewoud Y, Mighton L, Camelon K, O'Rourke R, Blodgett J, Sako E, Nicastro J, Prescott R, Rihal C, Kennedy F, Barsness G, Basu A, Clavell A, Frye R, Holmes DR Jr, Lerman A, Mullaney C, Reeder G, Rizza R, Schaff H, Smith S, Somers V, Sundt T, Ting H, Wright RS, Helgemoe P, Lesmeister D, Rolbiecki D, Lepe-Montoya L, Escobedo J, Barraza R, Baleón R, Campos A, García P, Lezama C, Miramontes C, Ocampo S, Peñafiel JV, Valdespino A, Verdín R, Albarrán H, Ayala F, Chávez E, Murillo H, Buitrón LV, Rico-Verdin B, Angulo F, Adler D, Halle AA, Ismail-Beigi F, Paranjape S, Mazzurco S, Ridley K, Ramanathan K, Solomon S, Wall B, Weinman D, Touchstone T, Douglas L, Bourassa M, Tardif JC, Chiasson JL, Lavoie MA, Rabasa-Lhoret R, Langelier H, Foucher S, Trudel J, Monrad S, Srinivas V, Zonszein J, Crandall J, Duffy H, Vartolomei E, King S 3rd, Jacobs C, Robertson D, Porter M, Eley M, Nichols E, LaCorte J, Mock M, Rogers W, Ovalle F, Bell D, Misra VK, Hillegass WB, Aqel R, Pierce P, Smith M, Saag L, Vaughn A, Smith D, Grimes T, Rolli S, Hill R, Barrett BD, Morehead C, Doss K, Davidson CJ, Molitch M, Beohar N, Massaro E, Goodreau L, Arroyo F, Neužil P, Pavlíĉková L, Stehlíková Š, Benedik J, Coling L, Davies R, Glover C, LeMay M, Mesana T, Ooi TC, Silverman M, Sorisky A, Favreau C, McClinton S, Weiss M, Weiss I, Saulle L, Kannam H, Kurylas JC, Vasi L, Douglas J Jr, Ghazzal Z, Sperling L, King S 3rd, Dayamani P, Gebhart S, Basu S, Helmy T, Tangpricha V, Hyde P, Jenkins M, Grant BP, Kent K, Suddath W, Magee M, Julien-Williams P, Reed V, Nassar C, Dagenais G, Garceau C, Auger D, Buller C, Elliott T, Ramanathan K, Ricci D, Fox R, Kolesniak D, Attubato M, Feit F, Richardson S, Sing IP, Slater J, Amendola A, Vargas B, Tsapatsaris N, Woods B, Cushing G, Rutter MK, Singh P, DesRochers G, Woodhead G, Gannon D, Campbell NS, Ragosta M, Sarembock I, Powers E, Barrett E, Jahn L, Murie K, Das G, Sigurdsson G, White C, Bantle J, Redmon J, Kwong C, Tamis-Holland J, Albu J, Hochman JS, Slater J, Wilentz J, Frances S, Tormey D, Pepine C, Smith K, Kennedy L, Brezner K, Curry T, Bleyer F, Albert S, Mooradian A, Plummer S, Fuentes F, Robles R, Lavis V, Gomez J, Iliescu C, Underwood C, Fulton MS, Ramirez JG, Merta J, Scott G, Krishnaswami A, Dowdell L, Berkheimer S, Greenbaum A, Whitehouse F, Pangilinan R, Mann K, Jacobs AK, Sternthal E, Ebner S, Nedeljkovic Z, Beardsley P, Schneider D, Pratley R, Cefalu W, Schnure J, Rowen M, Tilton L, Niederman A, Mata C, Kellerman T, Farmer J, Garber AJ, Kleiman N, Howard N, Nichols D, Pool M, Granger C, Feinglos M, Adams G, Green J, Druken B, Underwood D, Stafford J, Donner T, Laskey W, Beach D, Lopez J, Davis A, Faxon D, Reutrakul S, Bayer E, Marroquin O, Cohen H, Korytkowski M, Koerbel G, Baxendell L, Rosenfelder D, DeRiso L, Farrell C, Vita T, McGill J, Krone R, Bach R, Recklein C, Luepke KM, Clifton MJ, Farkouh ME, Kim MC, Smith DA, Guzman I, Travis A, O'Keefe J, Forker A, Isley W, Moe R, Kennedy P, Rosson M, Long A, Bates E, Herman W, Pop-Busui R, Duvernoy C, Stevens M, Luciano A, Majors C, Gottlieb SH, Rodriguez A, Herr M, Williams D, Smith RJ, Abbott J, Laufgraben MJ, Grogan M, Muratori J, Habib G, Marcelli M, Mikati I, Cordero E, Caldwell G, Schechter D, Lorber D, August P, Brown M, Depree P, Huber K, Hanusch-Enserer U, Jordanova N, Cilesiz D, Vogel B, McCallister B Jr, Kleerekoper M, Mandagere K, Urbanic R, Bengston J, Kong BK, Pruitt A, Sanfield J, Carulli C, Churley-Strom R, Magorien R, Osei K, Boyer CC, Lee R, Palumbo P, Wisbey J, Alderman E, Ikeno F, Schwarzkopf A, Steffes M, Nowicki M, Bucksa J, Chaitman B, Eckstein J, Stocke K, Hlatky MA, Boothroyd DB, Melsop KA, Sobel BE, Rowen M, Neimane D, Iskandrian AE, Schaaf MB, Genuth S, Bongarno T, Nesto R, August P, Hultberg K, Gottlieb SH, Albu J, Rosenhouse-Romeo H, Orchard TJ, Pambianco G, Lombardero M, Mock M, Frye RL, Brooks MM, Desvigne-Nickens P, Ershow A, Genuth S, Goldberg S, Gordon D, Hardison R, Jones TL, Kelsey S, Nesto R, Orchard T, Paltoo D, Rosenberg Y, Ryan T, Lebovitz H, Brown R, Friesinger G, Horton E, Mason J, Virmani R, Wechsler L, Bairey-Merz C, Kennedy J, Gordon D, Antman E, Colwell J, Fowler S, Furberg C, Goldman L, Jennings B, Rankin S.

Author information

1
From the Divisions of Cardiovascular Medicine (B.M.E., D.L.B.) and Preventive Medicine (B.M.E.), Brigham and Women's Hospital and Harvard Medical School, Boston; the Department of Epidemiology and Graduate School of Public Health, University of Pittsburgh, Pittsburgh (M.M.B., H.E.A.V.); Center for Cardiovascular Care, Saint Louis University School of Medicine, St. Louis (B.R.C.); and the Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (R.L.F.).

Abstract

BACKGROUND:

Cardiac troponin concentrations are used to identify patients who would benefit from urgent revascularization for acute coronary syndromes. We hypothesized that they might be used in patients with stable ischemic heart disease to identify those at high risk for cardiovascular events who might also benefit from prompt coronary revascularization.

METHODS:

We measured the cardiac troponin T concentration at baseline with a high-sensitivity assay in 2285 patients who had both type 2 diabetes and stable ischemic heart disease and were enrolled in the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes trial. We tested for an association between the troponin T concentration and a composite end point of death from cardiovascular causes, myocardial infarction, or stroke; we then evaluated whether random assignment to prompt revascularization reduced the rate of the composite end point in patients with an abnormal troponin T concentration (≥14 ng per liter) as compared with those with a normal troponin T concentration (<14 ng per liter).

RESULTS:

Of the 2285 patients, 2277 (99.6%) had detectable (≥3 ng per liter) troponin T concentrations and 897 (39.3%) had abnormal troponin T concentrations at baseline. The 5-year rate of the composite end point was 27.1% among the patients who had had abnormal troponin T concentrations at baseline, as compared with 12.9% among those who had had normal baseline troponin T concentrations. In models that were adjusted for cardiovascular risk factors, severity of diabetes, electrocardiographic abnormalities, and coronary anatomy, the hazard ratio for the composite end point among patients with abnormal troponin T concentrations was 1.85 (95% confidence interval [CI], 1.48 to 2.32; P<0.001). Among patients with abnormal troponin T concentrations, random assignment to prompt revascularization, as compared with medical therapy alone, did not result in a significant reduction in the rate of the composite end point (hazard ratio, 0.96; 95% CI, 0.74 to 1.25).

CONCLUSIONS:

The cardiac troponin T concentration was an independent predictor of death from cardiovascular causes, myocardial infarction, or stroke in patients who had both type 2 diabetes and stable ischemic heart disease. An abnormal troponin T value of 14 ng per liter or higher did not identify a subgroup of patients who benefited from random assignment to prompt coronary revascularization. (Funded by the National Institutes of Health and Roche Diagnostics; BARI 2D ClinicalTrials.gov number, NCT00006305.).

PMID:
26267622
PMCID:
PMC4627639
DOI:
10.1056/NEJMoa1415921
[Indexed for MEDLINE]
Free PMC Article

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