• Stig Lyngbæk, Per Winkel, Jens P Gøtze, Jens Kastrup, Christian Gluud, Hans Jørn Kolmos, Erik Kjøller, Gorm Boje Jensen, Jørgen Fischer Hansen, Per Hildebrandt, Jørgen Hilden, and CLARICOR Trial Group.
• Copenhagen University Hospital, Glostrup, Denmark stiglyngbaek@gmail.com.
• Eur J Prev Cardiol. 2014 Oct 1;21(10):1275-84.

AimsLow prevalence of detectable cardiac troponin in healthy people and low-risk patients previously curtailed its use. With a new high-sensitive cardiac troponin assay (hs-cTnT), concentrations below conventional detection may have prognostic value, notably in combination with N-terminal pro-B-type natriuretic peptide (NT-pro-BNP).Methods And ResultsBiomarker concentrations were determined from serum obtained at enrolment in the CLARICOR trial involving 4197 patients with stable coronary artery disease (CAD) followed for 2.6 years. Serum hs-cTnT was detectable (above 3 ng/l) in 78% and above the conventional 99th percentile (13.5 ng/l) in 23%. Across all levels of hs-cTnT there was a graded increase in the risk of cardiovascular death after adjustment for known prognostic indicators: hazard ratio (HR) per unit increase in the natural logarithm of the hs-cTnT level, 1.49; 95% confidence interval (CI), 1.23-1.81; similarly for all-cause mortality (HR 1.48, 95% CI 1.29-1.70) and myocardial infarction (HR 1.37, 95% CI 1.13-1.67). Increasing values of hs-cTnT were associated with increased mortality across all values of NT-pro-BNP, but this was particularly prominent when NT-pro-BNP >400 ng/l.ConclusionsIn patients with stable CAD, any detectable hs-cTnT level is significantly associated with all-cause mortality, cardiovascular death, and myocardial infarction after adjustment for traditional risk factors and NT-pro-BNP. Excess mortality is particularly pronounced in patients with NT-pro-BNP >400 ng/l.© The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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