This article is more than 5 years old. Information may no longer be current.
Q&A: High-sensitivity troponin predicts obstructive CAD in stable chest discomfort
Click Here to Manage Email Alerts
Concentrations of high-sensitivity troponin were measurable with the use of a single molecule counting assay in less acute patients, such as those with stable chest discomfort in the outpatient setting, according to new results from the PROMISE trial.
The analysis by James L. Januzzi Jr., MD, cardiologist at Massachusetts General Hospital and professor of medicine at Harvard Medical School, and colleagues was designed to understand distribution of high-sensitivity troponin I (hsTnI) in patients with stable chest pain, define predictors of hsTnI in the cohort and to evaluate diagnostic meaning of hsTnI concentrations relative to presence and severity of obstructive CAD as identified by subsequent coronary CT angiography.
The researchers found that log-hsTnI concentrations independently predicted 50% stenosis in any vessel 2 mm and 70% stenosis in any vessel 2 mm or 50% stenosis of the left main coronary artery.
Cardiology Today spoke with Januzzi about the merits of the study results, the effect it will have on the field of cardiology and the research that still remains.
Question: Why was it so important for you and your colleagues to undertake the PROMISE trial ?
Answer: The PROMISE trial was an important study, as symptoms of stable chest discomfort are exceedingly common, and at present we lack defined strategies to well-address this frequently encountered patient population.
Q: What is your experience with single molecule c ounting (SMC) technology and what role does it play in the presentation of this study?
A: The SMC hsTnI (Singulex) is the most sensitive assay I've worked with. It can detect concentrations of troponin in the majority of normal subjects. Given we suspected concentrations of hsTnI would reflect cardiovascular risk and possibly predict presence of coronary artery disease in those with measurably elevated values (without a myocardial infarction), we hypothesized utility of hsTnI for predicting presence and severity of CAD in patients undergoing coronary CT scanning.
Q: What are some of the implications for patients presenting with stable chest discomfort and health professionals?
A: More work is needed, but our results suggest that testing for hsTnI might be an important support to clinical judgment and other testing to help clarify whether a patient with stable chest discomfort might require more aggressive/invasive evaluation.
Q: What are some of the challenges moving forward and what are the next steps for your colleagues for this research?
A: The biggest challenge we presently face is to ascertain what role hsTnI testing plays relative to clinical judgment and other testing such as ECG, stress testing, echo or CT angiography. We are presently exploring this question in numerous analyses.
Q: What role will the results of the study play in cost- effectiveness for those in this patient set?
A: Cost-effectiveness is particularly important to establish here. Once we’ve developed a sense of how hsTnI might be added to the clinical evaluation of patients with stable chest discomfort, it will be very necessary to establish not only cost-saving, but cost-effectiveness associated with use of hsTnI.
Disclosure: Januzzi reports he receives grant funding from Abbott, Roche and Singulex.