Association of contemporary sensitive troponin I levels at baseline and change at 1 year with long-term coronary events following myocardial infarction or unstable angina: results from the LIPID study (Long-Term Intervention with Pravastatin in Ischaemic

White, Harvey D., Tonkin, Andrew, Simes, John, Stewart, Ralph, Mann, Kristy, Thompson, Peter, Colquhoun, David, West, Malcolm, Nestel, Paul, Sullivan, David, Keech, Anthony C., Hunt, David, Blankenberg, Stefan and for the LIPID Study Investigators (2014) Association of contemporary sensitive troponin I levels at baseline and change at 1 year with long-term coronary events following myocardial infarction or unstable angina: results from the LIPID study (Long-Term Intervention with Pravastatin in Ischaemic. Journal of the American College of Cardiology, 63 4: 345-354. doi:10.1016/j.jacc.2013.08.1643


Author White, Harvey D.
Tonkin, Andrew
Simes, John
Stewart, Ralph
Mann, Kristy
Thompson, Peter
Colquhoun, David
West, Malcolm
Nestel, Paul
Sullivan, David
Keech, Anthony C.
Hunt, David
Blankenberg, Stefan
for the LIPID Study Investigators
Total Author Count Override 13
Title Association of contemporary sensitive troponin I levels at baseline and change at 1 year with long-term coronary events following myocardial infarction or unstable angina: results from the LIPID study (Long-Term Intervention with Pravastatin in Ischaemic
Journal name Journal of the American College of Cardiology   Check publisher's open access policy
ISSN 0735-1097
1558-3597
Publication date 2014-02-04
Year available 2013
Sub-type Article (original research)
DOI 10.1016/j.jacc.2013.08.1643
Open Access Status DOI
Volume 63
Issue 4
Start page 345
End page 354
Total pages 10
Place of publication San Diego, CA, United States
Publisher Elsevier
Collection year 2015
Language eng
Formatted abstract
Objectives
This study sought to assess whether baseline and change in contemporary sensitive troponin I (TnI) levels predicts coronary heart disease (CHD) death and myocardial infarction (MI), and to determine the effects of pravastatin on TnI levels.

Background
The role of troponins in predicting long-term outcomes in patients with stable CHD is not clearly defined.

Methods
The LIPID (Long-Term Intervention With Pravastatin in Ischaemic Disease) study randomized patients with cholesterol levels of 155 to 271 mg/dl 3 to 36 months after MI or unstable angina to placebo or pravastatin 40 mg per day. TnI levels were measured at baseline and after 1 year in 7,863 patients. Median follow-up was 6 years. Change in TnI was defined as moving up or down 1 tertile or ≥50% change.

Results
Baseline TnI tertiles were <0.006 ng/ml, 0.006 to <0.018 ng/ml, and ≥0.018 ng/ml. TnI levels were related to CHD death and MI after adjustment for 23 risk factors and treatment (≥0.018 ng/ml vs. <0.006 ng/ml hazard ratio [HR]: 1.64; 95% CI: 1.41 to 1.90; p < 0.001). TnI levels increased in 23.0%, were unchanged in 51.3%, and decreased in 25.7% of patients. Pravastatin decreased TnI levels by 0.003 ng/ml versus placebo (p = 0.002). In landmark analyses, increases in TnI levels were associated with increased numbers of CHD death and MI (HR: 1.31; 95% CI: 1.06 to 1.62) and decreases with decreased risk (HR: 0.90; 95% CI: 0.74 to 1.09; overall p = 0.01). Data were similar with 50% change criteria. Net reclassification improvement by adding TnI to the baseline model for CHD death and MI was 4.8% (p = 0.01).

Conclusions
Baseline TnI levels and change at 1 year are independent predictors of CHD death and MI. TnI levels are strong predictors of risk, and change modifies risk.
Keyword Coronary heart disease
LIPID
Mortality
Troponin I
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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