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High-Sensitivity Troponins and Mortality in the General Population
Quick Takes
- This study examined the correlations between four high-sensitivity (hs) assays used for measuring cardiac troponin T (Roche) and I (Abbott, Siemens, Ortho) in a cohort of 9,810 adults without CVD, with the intent of understanding their comparative associations with mortality.
- The correlation between assays was surprisingly modest, ranging from 0.53 to 0.77. Each hs troponin assay was independently associated with all-cause mortality and CV mortality.
- These findings suggest that each assay provides somewhat distinct information about troponin levels. Which assay is best for a particular clinical question remains to be determined.
Study Questions:
In adults without cardiovascular disease (CVD), how do the correlations between four high-sensitivity (hs) assays used for measuring cardiac troponin T and I compare, and what are their comparative associations with all-cause mortality and cardiovascular (CV) mortality?
Methods:
This is an observational, retrospective cohort study that utilized data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES). The study population consisted of 9,810 adults without a history of CVD in whom cardiac troponin T and I were measured using four hs assays: one for troponin T (Roche) and three for troponin I (Abbott, Siemens, and Ortho). The authors examined the correlation between assays, as well as their association with outcomes. The primary outcome of the study was the mortality rate, both all-cause and CV, in relation to the levels of troponin T and I, as measured by the different assays.
Results:
The cohort included 9,810 participants (mean age 44.3 years, 52.7% women). Over a median follow-up of 17.2 years, there were 2,188 deaths, of which 488 were due to CV causes. The prevalence of elevated troponin varied across the assays, with the highest prevalence observed for the Roche troponin T assay (3.11%) and the lowest for the Abbott troponin I assay (0.60%). The correlations between the four hs assays used for measuring cardiac troponin T and I were modest, with Pearson’s correlation coefficients ranging from 0.53 to 0.77. All four assays were independently associated with all-cause mortality, with hazard ratios (HRs) ranging from 1.10 (95% confidence interval [CI], 1.02–1.18) for the Siemens hs-troponin I assay to 1.31 (95% CI, 1.21–1.42) for the Roche hs-troponin T assay. Each hs-troponin assay was also independently associated with CV mortality, with HRs ranging from 1.44 to 1.65 per 1 standard deviation (SD). Risk discrimination improved when combining assays. Troponin I assays were not independent predictors of non-CV death when adjusting for hs-troponin T levels.
Conclusions:
The authors conclude that correlations between hs-troponin T and the three hs-troponin I assays are modest and provide additive risk discrimination.
Perspective:
This study is an important contribution to the field, as it provides a direct comparison of the hs-troponin assays commonly measured in the clinical settings. The findings are intriguing, as a modest correlation was noted between the different assays, as well as additive risk discrimination, suggesting that each assay may provide unique insights into patient risk and pathobiology, which could have implications for personalized medicine. The association between troponin T and non-CV mortality is a reflection of its nonspecific nature, as it is re-expressed by injured or diseased skeletal muscle. The study also raises questions about the optimal use of these assays. For instance, which assay should be used in which circumstances? How should the results be interpreted in the context of other clinical information? Further research is needed to answer these questions and to fully realize the potential of hs-troponin assays in clinical practice.
Clinical Topics: Prevention
Keywords: Mortality, Myocardial Ischemia, Outcome Assessment, Health Care, Primary Prevention, Risk, Troponin I, Troponin T
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