Comparison of the Association Between High-Sensitivity Troponin I and Adverse Cardiovascular Outcomes in Patients With Versus Without Chronic Kidney Disease.

Abstract

It is unknown whether the association of high-sensitivity troponin I (hs-TnI) with adverse cardiovascular outcomes varies by the presence of chronic kidney disease (CKD). We examined the association of hs-TnI with adverse cardiovascular outcomes in those with and without CKD in 4,107 (mean age, 64 years; 63% men; 20% black) patients from the Emory Cardiovascular Biobank who underwent coronary angiography. CKD (n = 1,073) was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2 or urine albumin/creatinine ratio >30 mg/g at baseline. Cox regression was used to compute hazard ratios (HR) for the association between hs-TnI levels (per doubling of hs-TnI: log2[hs-TnI] + 1) and death, cardiovascular death, and major adverse cardiac events (MACE), separately. Hs-TnI was a stronger predictor of death (CKD: HR 1.23, 95% confidence interval [CI] 1.15 to 1.31; no CKD: HR 1.11, 95% CI 1.05 to 1.17, p-interaction = 0.023), cardiovascular death (CKD: HR 1.24, 95% CI 1.14 to 1.34; no CKD: HR 1.15, 95% CI 1.07 to 1.22, p-interaction = 0.12), and MACE (CKD: HR 1.18, 95% CI 1.11 to 1.25; no CKD: HR 1.11, 95% CI 1.06 to 1.16, p-interaction = 0.095) in CKD compared with non-CKD. The association between hs-TnI and death in patients with CKD was stronger for patients without obstructive coronary artery disease (no obstructive coronary artery disease: HR 1.60, 95% CI 1.27 to 2.01; obstructive coronary artery disease: HR 1.19, 95% CI 1.11 to 1.27, p-interaction = 0.041). In conclusion, hs-TnI is a stronger predictor of adverse cardiovascular events in patients who have CKD than those without, even in the absence of obstructive coronary artery disease. Hs-TnI may identify CKD patients who are high risk for adverse cardiovascular outcomes in whom aggressive risk factor modification strategies are warranted.

• Authors: Pratik B Sandesara, Wesley T O'Neal, Ayman Samman Tahhan, Salim S Hayek, Suegene K Lee, Jay Khambhati, Matthew L Topel, Muhammad Hammadah, Ayman Alkhoder, Yi-An Ko, Mohamad Mazen Gafeer, Agim Beshiri, Gillian Murtagh, Jonathan H Kim, Peter Wilson, Leslee Shaw, Stephen E Epstein, Laurence S Sperling, Arshed A Quyyumi
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 121 Issue 12 Pg. 1461-1466 (06 15 2018) ISSN: 1879-1913 [Electronic] United States
• PMID: 29628129 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Chemical References

• Troponin I

Topics

• Aged
• Aged, 80 and over
• Cardiovascular Diseases (mortality)
• Case-Control Studies
• Cause of Death
• Coronary Artery Disease (blood, epidemiology)
• Female
• Humans
• Male
• Middle Aged
• Mortality
• Myocardial Infarction (epidemiology)
• Myocardial Revascularization (statistics & numerical data)
• Prognosis
• Proportional Hazards Models
• Renal Insufficiency, Chronic (blood, epidemiology)
• Troponin I (blood)
• United States (epidemiology)