High-Sensitivity Troponin I and Coronary Computed Tomography in Symptomatic Outpatients With Suspected Coronary Artery Disease. Insights From the PROMISE Trial

James L. Januzzi, Sunil Suchindran, Adrian Coles, Maros Ferencik, Manesh R. Patel, Udo Hoffmann, Geoffrey S. Ginsburg, Pamela S. Douglas

    Research output: Contribution to journalArticle

    13 Citations (Scopus)

    Abstract

    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.).

    Original languageEnglish (US)
    JournalJACC: Cardiovascular Imaging
    DOIs
    StateAccepted/In press - Jan 1 2018

    Fingerprint

    Troponin I
    Chest Pain
    Multicenter Studies
    Coronary Artery Disease
    Outpatients
    Tomography
    Coronary Vessels
    Calcium
    Pathologic Constriction
    Odds Ratio
    Logistic Models
    Myocardial Infarction
    Demography

    Keywords

    • Coronary artery disease
    • Coronary computed tomography angiography
    • Troponin

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging
    • Cardiology and Cardiovascular Medicine

    Cite this

    High-Sensitivity Troponin I and Coronary Computed Tomography in Symptomatic Outpatients With Suspected Coronary Artery Disease. Insights From the PROMISE Trial. / Januzzi, James L.; Suchindran, Sunil; Coles, Adrian; Ferencik, Maros; Patel, Manesh R.; Hoffmann, Udo; Ginsburg, Geoffrey S.; Douglas, Pamela S.

    In: JACC: Cardiovascular Imaging, 01.01.2018.

    Research output: Contribution to journalArticle

    Januzzi, James L. ; Suchindran, Sunil ; Coles, Adrian ; Ferencik, Maros ; Patel, Manesh R. ; Hoffmann, Udo ; Ginsburg, Geoffrey S. ; Douglas, Pamela S. / High-Sensitivity Troponin I and Coronary Computed Tomography in Symptomatic Outpatients With Suspected Coronary Artery Disease. Insights From the PROMISE Trial. In: JACC: Cardiovascular Imaging. 2018.
    @article{4d4b952a65da43b9b465cb23335ff329,
    title = "High-Sensitivity Troponin I and Coronary Computed Tomography in Symptomatic Outpatients With Suspected Coronary Artery Disease. Insights From the PROMISE Trial",
    abstract = "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.).",
    keywords = "Coronary artery disease, Coronary computed tomography angiography, Troponin",
    author = "Januzzi, {James L.} and Sunil Suchindran and Adrian Coles and Maros Ferencik and Patel, {Manesh R.} and Udo Hoffmann and Ginsburg, {Geoffrey S.} and Douglas, {Pamela S.}",
    year = "2018",
    month = "1",
    day = "1",
    doi = "10.1016/j.jcmg.2018.01.021",
    language = "English (US)",
    journal = "JACC: Cardiovascular Imaging",
    issn = "1936-878X",
    publisher = "Elsevier Inc.",

    }

    TY - JOUR

    T1 - High-Sensitivity Troponin I and Coronary Computed Tomography in Symptomatic Outpatients With Suspected Coronary Artery Disease. Insights From the PROMISE Trial

    AU - Januzzi, James L.

    AU - Suchindran, Sunil

    AU - Coles, Adrian

    AU - Ferencik, Maros

    AU - Patel, Manesh R.

    AU - Hoffmann, Udo

    AU - Ginsburg, Geoffrey S.

    AU - Douglas, Pamela S.

    PY - 2018/1/1

    Y1 - 2018/1/1

    N2 - 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.).

    AB - 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.).

    KW - Coronary artery disease

    KW - Coronary computed tomography angiography

    KW - Troponin

    UR - http://www.scopus.com/inward/record.url?scp=85043514028&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85043514028&partnerID=8YFLogxK

    U2 - 10.1016/j.jcmg.2018.01.021

    DO - 10.1016/j.jcmg.2018.01.021

    M3 - Article

    C2 - 29550314

    AN - SCOPUS:85043514028

    JO - JACC: Cardiovascular Imaging

    JF - JACC: Cardiovascular Imaging

    SN - 1936-878X

    ER -