Physicians' Academy for Cardiovascular Education

Prognostic value of high sensitivity troponin I in diabetic post-ACS patients

Serial Measurement of High Sensitivity Troponin I and Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus in the EXAMINE Trial

Cavender MA, White WB, Jarolim R, et al. - Circulation 2017; published online ahead of print


High sensitivity cardiac troponin I (hsTnI) is useful for the identification of type 2 diabetes mellitus (T2DM) patients at high risk of cardiovascular (CV) events [1-3]. In the phase IIIb EXAMINE study, the CV safety of alogliptin, a non-selective DPP-4 inhibitor, was assessed in post-ACS patients (n=5380) with T2DM [4,5].

In this analysis of the EXAMINE study, the relationship of hsTnI changes (from baseline to six months) with outcome, as well as the CV safety of alogliptin in patients at highest CV risk were evaluated.

Main results


The majority of T2DM patients with established ischemic heart disease have detectable levels of hsTnI. The magnitude of hsTnI elevation is an independent predictor of both ischemic and heart failure events. Compared with placebo, alogliptin did not increase the risk of major CV events in patients at highest risk based on the degree of hsTnI elevation. These findings contribute to the understanding of the role of hsTnI as a predictor of major CV events in T2DM patients.


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Find this article online at Circulation