Physicians' Academy for Cardiovascular Education

Changes in serial hsTnT associated with risk of subsequent CV events in stabilized ACS

Association of serial high-sensitivity cardiac troponin T with subsequent cardiovascular events in patients stabilized after acute coronary syndrome: a secondary analysis from IMPROVE-IT

Literature - Patel SM, Qamar A, Giugliano RP, et al. - JAMA Cardiol. 2022 Dec 1;7(12):1199-1206. doi: 10.1001/jamacardio.2022.3627.

Introduction and methods

Background

Determination of high-sensitivity troponin-T (hsTnT) levels plays a role not only in the diagnosis of ACS, but also in risk stratification for secondary prevention in CVD [1-6]. For example, reclassification based on hsTnT levels may be useful to guide intensive blood pressure and lipid lowering [5,7]. In patients with DM and ischemic heart disease, small absolute changes in serial hsTnT provided incremental prognostic information [8]. However, data on the implications of such changes in patients with ACS are limited. A previous secondary analysis of the IMPROVE-IT trial showed that in these patients, a single measurement of hsTnT levels 1 month after stabilization post-ACS was associated with the risk of subsequent CV events [1].

Aim of the study

This secondary analysis of the IMPROVE-IT trial examined the association of changes in serial hsTnT with the risk of subsequent CV events in high-risk patients with stabilized ACS.

Methods

The IMPROVE-IT trial is an international, multicenter, double-blind RCT in which 18,144 patients with stabilized ACS were randomized to ezetimibe or placebo, in addition to simvastatin. Patients aged 50 years or older who had been hospitalized in the past 10 days because of STEMI, NSTEMI, or unstable angina were eligible to participate if they had at least 1 high-risk factor and LDL-c levels of 50-125 mg/dL (or 50-100 mg/dL for patients receiving chronic statin therapy), and were stabilized for at least 24 hours prior to randomization. This secondary analysis involved 6035 patients (24.6% female) in whom hsTnT levels were measured at 1 and 4 months. The median follow-up was 6 years.

Outcomes

The outcomes of interest were the composite of CV death, myocardial infarction, stroke, or hospitalization for HF, and the individual end point components.

Main results

Conclusion

This secondary analysis of the IMPROVE-IT trial shows a graded association of changes in serial hsTnT levels with the risk of subsequent CV events in high-risk patients with stabilized ACS. This association is independent of hsTnT concentration at 1 month.

References

Show references

Find this article online at JAMA Cardiol.

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