Prognostic utility of high-sensitivity troponins according to atherosclerotic vascular disease severity

BACKGROUND AND AIMS: Patients with atherosclerotic vascular disease (ASVD) affecting two or more different vascular beds, so called Polyvascular disease (PolyVD), are at an increased risk for adverse outcomes. In those patients, the prognostic utility of high-sensitivity troponin T and I (hsTnT/I) is under-investigated. We therefore aimed to explore the association between hsTnT/I with the extent of ASVD and outcomes in a contemporary cohort.

METHODS: Patients undergoing coronary angiography with available hsTnT/I concentrations from the cohort study INTERCATH were included. Subgroups of patients without ASVD, monovascular disease (MVD), and PolyVD were created. Cox regression analyses were computed to investigate the associations of hsTnT/I with the extent of ASVD and clinical outcomes (all-cause mortality and major adverse cardiovascular events; MACE).

RESULTS: In 2273 included patients, a stepwise increase of both hsTnT and hsTnI was observed according to the extent of ASVD. However, this association was statistically not significant after adjustment. hsTnT and hsTnI were independently associated with all-cause mortality for PolyVD (adjusted hazard ratio per standard deviation for hsTnT: 1.42 [95 %-CI: 1.16, 1.73]; p < 0.001 and hsTnI: 1.38 [1.14, 1.68]; p = 0.0013) and MVD (hsTnT: 1.32 [1.15, 1.51]; p < 0.001 and hsTnI: 1.35 [1.17, 1.56]; p < 0.001), whereas no association of hsTn with MACE was seen across the burden of ASVD.

CONCLUSIONS: Patients with a greater extent of ASVD had higher concentrations of hsTnT/I and an increased incidence of all-cause mortality as well as MACE. hsTnT/I concentrations were reliably linked to all-cause mortality in patients with ASVD, underscoring the role of biomarkers in risk prediction.