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Premorbid levels of high-sensitivity cardiac troponin T and natriuretic peptide and prognosis after incident myocardial infarction.

TitlePremorbid levels of high-sensitivity cardiac troponin T and natriuretic peptide and prognosis after incident myocardial infarction.
Publication TypeJournal Article
Year of Publication2019
AuthorsMok Y, Sang Y, Ballew SH, Hoogeveen RC, Ballantyne CM, Rosamond WD, Coresh JJ, Selvin E
Secondary AuthorsMatsushita K
JournalAm Heart J
Volume216
Pagination62-73
Date Published2019 10
ISSN1097-6744
KeywordsAged, Asymptomatic Diseases, Biomarkers, Cohort Studies, Female, Humans, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Myocardial Infarction, Natriuretic Peptide, Brain, Peptide Fragments, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Assessment, Sensitivity and Specificity, Survival Analysis, Troponin T, United States
Abstract

High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) at the time of myocardial infarction (MI) are strong predictors of prognosis. However, whether their premorbid (before MI occurrence) levels are associated with prognosis after incident MI is unknown.

METHODS: In 1,054 participants from the Atherosclerosis Risk in Communities Study with incident MI, we evaluated premorbid levels of hs-cTnT and NT-proBNP measured on median 5.8 (interquartile interval 3.0-11.5 [mean 5.5]) years prior to incident MI and their associations with subsequent composite and individual outcomes of all-cause mortality, cardiovascular mortality, recurrent MI, heart failure, and stroke.

RESULTS: During a median follow-up of 3.0 years after MI, 801 participants developed the composite outcome. Both hs-cTnT and NT-proBNP were independently associated with the composite outcome after incident MI. Among individual outcomes, all-cause mortality, cardiovascular mortality, and heart failure showed significant associations with both cardiac markers. Overall, NT-proBNP demonstrated a more evident relationship than hs-cTnT. Indeed, the addition of premorbid NT-proBNP alone, but not hs-cTnT alone, to conventional predictors at incident MI significantly improved risk prediction of the composite outcome after incident MI (Δc-statistic 0.013 [95% CI 0.005-0.022] from 0.691 with conventional predictors).

CONCLUSIONS: Premorbid levels of hs-cTnT and NT-proBNP assessed on average 6 years prior to incident MI were associated with adverse outcomes after incident MI. These results further highlight the importance of cardiac health at an earlier stage of life.

DOI10.1016/j.ahj.2019.07.002
Alternate JournalAm Heart J
PubMed ID31404723
PubMed Central IDPMC6842707
Grant ListR01 DK089174 / DK / NIDDK NIH HHS / United States
HHSN268201700001I / HL / NHLBI NIH HHS / United States
HHSN268201700004I / HL / NHLBI NIH HHS / United States
R01 HL134320 / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States