HsTnT in Stable Coronary Artery Disease
HsTnT in Stable Coronary Artery Disease
Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality
 worldwide. Life threatening manifestations such as acute myocardial infarction (AMI) and
 sudden cardiac death are the most important causes of death in many countries. Cardiac
 troponin is a biomarker with a high specificity for cardiac necrosis and is recommended for
 diagnosis of acute myocardial infarction by the Universal definition of myocardial
 infarction. Since a new generation of high-sensitivity cardiac troponin assays has become
 commercially available a few years ago, myocardial infarction can be detected earlier and
 even small AMIs, that were classified as unstable angina pectoris (UAP) with the less
 sensitive assays, are detectable now. On the other side, more patients with acute or chronic
 myocardial damage not due to AMI are identified now. Thereby, the reason for elevated
 troponin levels should be sought actively, because high troponin levels were associated with
 adverse outcome - independent of the underlying pathomechanism. The reasons for troponin
 elevations in patients with stable CAD are not clear yet. Associations with extensive
 atherosclerosis, carotid lesions and complex coronary plaques in coronary CT scans were
 reported. Therefore, patients with elevated troponin levels represent a risk population and
 might profit from intensified secondary prevention. In this context, ticagrelor might be part
 of a prevention strategy as currently tested in the PEGASUS trial.

 We plan to conduct a single-centre pilot study in a cohort with clinically stable patients of
 our outpatient clinic, because data regarding prevalence, causes and prognosis of elevated
 troponin values in unselected cohorts is sparse. Therefore, all patients (n=910) that
 presented to our outpatient clinic 12 months after introduction of the high-sensitivity
 troponin T assay (june 2009) and were free of complaints or presented with UAP are being
 enrolled. All patients are characterized by demographic, laboratory and clinical
 characteristics (including medication) and all available imaging data (exercise-ecg,
 echocardiography, stress-echocardiography, computed tomography, cardiac MRI and coronary
 angiography) in order to compare baseline characteristics of troponin positive and troponin
 negative patients. In addition, the Framingham- and PROCAM-Score representing established
 calculators of long-term risk prediction are calculated.

 Prognostic endpoints are defined as severe cardiovascular events and progress of the
 initially diagnosed disease. Those endpoints are associated with the initial hs-cTnT value
 and serial changes.
Inclusion Criteria:

 -  Patients of outpatient clinic presenting 12 months after introduction of the hs-TnT
 test in june 2009

 Exclusion Criteria:

 -  none