Serial troponin I measurement predicted risk for patients with stable ischemic heart disease

SAN FRANCISCO — Monitoring levels of cardiac troponin I identified post-ACS patients at heightened risk for future death from CVD or HF, according to new data from the PROVE-IT TIMI 22 trial.

"Using a next-generation investigational assay for cardiac troponin, we found that the vast majority of patients who were stable after ACS 4 months previously had detectable levels of circulating troponin and that that level was strongly associated with subsequent cardiac events," David A. Morrow, MD, director of the Levine Cardiac Intensive Care Unit at Brigham and Women's Hospital, told Cardiology Today.

David A. Morrow

Among 2,664 stable patients from the previously completed PROVE-IT TIMI 22 trial, serial measurements of troponin I (Erenna, Singulex) at 30 days and 4 months predicted CVD and HF death at 2-year follow-up.

Patients with newly elevated troponin I levels (≥9 pg/mL) were at the greatest risk, experiencing more than three times the rate of CVD or HF death within 2 years, compared with patients whose troponin I levels remained low (6% vs. 1.6%), according to data reported in a press release.

Serial high-sensitivity cardiac troponin I determination enhanced risk stratification for CVD and HF, as well as new MI, according to the researchers.

“Virtually all patients with stable ischemic heart disease, [defined as] history of ACS 4 months previously, had detectable serial measurements of troponin I and about one-fifth had cardiac troponin I [greater than] the 99th percentile cut-point using this investigational high-sensitivity assay,” the researchers concluded.

In an interview with Cardiology Today, Morrow said, “We have not previously thought of such stable patients who we are seeing in our clinics as having detectable evidence of myocardial injury. Importantly, measuring troponin in this population serially over time offered incremental prognostic information.

“Our findings take us another step toward a possible use of high-sensitivity cardiac troponin for disease monitoring in patients with stable ischemic heart disease.”

These data are in line with other data from PROVE-IT TIMI 22, presented at the American Heart Association Scientific Sessions in November, which showed that elevated cardiac troponin I is associated with increased risk for CVD or HF death at 2 years. Additionally, the earlier study suggested that patients with high cardiac troponin I levels gain the most therapeutic benefit from statin therapy vs. moderate dose therapy, according to the press release. – by Deb Dellapena

For more information:

Morrow DA. Poster # 1110M-73. Presented at: American College of Cardiology Scientific Sessions; March 9-11, 2013; San Francisco.

Disclosure: PROVE-IT TIMI 22 was supported by Bristol-Myers Squibb. Support for reagent and testing at 4 months were provided by Singulex.