Prognostic Impact of High-Sensitive Troponin T Assessment in Elderly Patients With Chronic Heart Failure: Results From the CORONA Trial
What is the incremental prognostic value of high-sensitive troponin T (hs-cTnT) in heart failure (HF) beyond that of high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) in a subgroup of patients from the CORONA (Controlled Rosuvastatin Multinational Trial in HF) study?
Hs-cTnT as a risk factor for the primary endpoint (cardiovascular [CV] death, nonfatal myocardial infarction, nonfatal stroke; n = 356), as well as all-cause mortality (n = 366), CV mortality (n = 299), and the composite of CV mortality and hospitalization from worsening of HF (n = 465) was investigated in 1,245 patients (ages ≥60 years, New York Heart Association [NYHA] class II-IV, ischemic systolic HF) randomly assigned to 10 mg rosuvastatin or placebo.
In multivariable analyses, adjusting for left ventricular ejection fraction, NYHA class, age, body mass index, diabetes, sex, intermittent claudication, heart rate, estimated glomerular filtration rate, apolipoprotein B (ApoB)/ApoA-1-ratio, NT-proBNP, hs-CRP, and hs-cTnT (both dichotomized according to the 99th percentile and as a continuous variable) was associated with all endpoints (primary endpoint: hazard ratio [HR], 1.87 and 1.51, respectively, per standard deviation change, p < 0.001; all other endpoints: HR, 1.39-1.70). However, improved discrimination as assessed by C-statistics was only seen for the primary endpoint and all-cause mortality.
The authors concluded that elevated hs-cTnT levels provide strong and independent prognostic information in older patients with chronic ischemic HF.
This study suggests that elevated hs-cTnT levels have a strong predictive and discriminating value for the primary endpoint, all-cause mortality, CV mortality, and the composite of CV mortality and hospitalizations due to worsening of HF, among older patients with chronic HF of ischemic origin. Importantly, changes in hs-cTnT provided inferior prognostic information than that of elevated baseline levels in the present study. Baseline hs-cTnT levels may help clinicians in determining prognosis as part of a multicomponent assessment in elderly patients with HF.
Keywords: Fluorobenzenes, Intermittent Claudication, Myocardial Infarction, Stroke, Chronic Disease, Troponin T, Apolipoprotein A-I, Pyrimidines, Risk Factors, Heart Rate, New York, Systole, Prognosis, Cytoskeletal Proteins, C-Reactive Protein, Body Mass Index, Biological Markers, Heart Failure, Stroke Volume, Glomerular Filtration Rate, Diabetes Mellitus, Sulfonamides, Natriuretic Peptide, Brain
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