Author + information
- Received December 8, 2017
- Revision received January 16, 2018
- Accepted January 18, 2018
- Published online November 14, 2018.
- James L. Januzzi Jr., MDa,b,∗ (, )@JJheart_doc,
- Sunil Suchindran, PhDc,
- Adrian Coles, PhDd,
- Maros Ferencik, MD, PhDe,
- Manesh R. Patel, MDd,
- Udo Hoffmann, MDf,
- Geoffrey S. Ginsburg, MDc,g,
- Pamela S. Douglas, MDd,g,
- on behalf of the PROMISE Investigators
- aCardiology Division, Massachusetts General Hospital, Boston, Massachusetts
- bBaim Institute for Clinical Research, Boston, Massachusetts
- cDuke Center for Applied Genomics and Precision Medicine, Durham, North Carolina
- dDuke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- eOregon Health and Science University, Portland, Oregon
- fDepartment of Radiology, Massachusetts General Hospital, Boston, Massachusetts
- gDepartment of Medicine, Duke University Medical School, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. James L. Januzzi, Jr., Cardiology Division, Massachusetts General Hospital, Yawkey 5984, 32 Fruit Street, Boston, Massachusetts 02114.
Objectives The goal of this study was to examine associations between concentrations of high-sensitivity troponin I (hsTnI) (measured by using a single-molecule counting method) and obstructive coronary artery disease (CAD) in 1,844 stable, symptomatic outpatients with suspected CAD randomized to undergo coronary computed tomography angiography (CTA) in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial.
Background Elevated concentrations of hsTnI are associated with CAD in patients with myocardial infarction. The meaning of hsTnI concentrations in stable symptomatic outpatients is not well understood.
Methods Clinical characteristics and CTA results (including coronary artery calcium [CAC] scores) were expressed across hsTnI quartiles. Determinants of hsTnI concentration were identified. Multivariable logistic regression identified independent predictors of obstructive CAD50 (≥50% stenosis in any vessel) and CAD70 (≥70% stenosis or ≥50% left main).
Results The median hsTnI concentration was 1.5 ng/l; nearly all (98.5%) subjects had measurable hsTnI, and 6.1% had concentrations ≥99th percentile concentration for this assay (6 ng/l). Higher CAC scores, as well as more prevalent and diffuse CAD, was seen in upper hsTnI quartiles (all p < 0.001). Independent predictors of hsTnI concentrations included age, sex, and CAC score (all p < 0.05). After adjusting for demographic and clinical characteristics, log-transformed hsTnI concentrations were associated with obstructive CAD50 (odds ratio = 1.15 per interquartile range; p = 0.02) and CAD70 (odds ratio = 1.25 per interquartile range; p = 0.001).
Conclusions In stable symptomatic outpatients undergoing nonemergent coronary CTA for the diagnosis of suspected CAD, higher concentrations of hsTnI were associated with increasing presence and severity of coronary atherosclerosis. (Prospective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550.)
This study was sponsored in part by an unrestricted grant from Singulex, Inc. This project was also supported by grants R01HL098237, R01HL098236, and R01HL98305 from the National Heart, Lung, and Blood Institute (NHLBI). The authors are solely responsible for the design and conduct of this study; all study analyses; and the drafting and editing of the paper and its final contents. This paper does not necessarily represent the official views of the NHLBI. Dr. Januzzi is supported in part by the Hutter Family Professorship in Cardiology; has received grant support from Singulex; consulting income from Roche Diagnostics, Critical Diagnostics, Philips, and Novartis; and participates in clinical endpoint committees/data safety monitoring boards for Siemens, AbbVie, Pfizer, Amgen, Janssen, and Boehringer Ingelheim. Dr. Ferencik was supported in part by American Heart Association Fellow to Faculty Award 13FTF16450001. Dr. Patel has received research grants from AstraZeneca, Janssen, Bayer, NHLBI, Philips, and HeartFlow; and serves on advisory boards for Janssen, AstraZeneca, and Bayer. Dr. Hoffmann has received research grants from HeartFlow, Kowa Pharmaceuticals, Siemens, Medimmune, and Pfizer. Dr. Ginsburg has served as a consultant or advisory board member for CardioDx, Interleukin Genetics, Pappas Ventures, Fabric Genomics, and Genome Magazine; has stock options from CardioDx, Alere, Fabric Genomics, and Origin Commercial Advisors; has served on the board of directors for Alere; and has received royalties from Elsevier and research funding to his institution from Singulex, Abbott, and 23andMe. Dr. Douglas has received research grants from GE and HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 8, 2017.
- Revision received January 16, 2018.
- Accepted January 18, 2018.
- 2018 American College of Cardiology Foundation
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