Prognostic value of subclinical myocardial necrosis using high-sensitivity cardiac troponin T in patients with prediabetes

Abstract

Background Risk stratification of patients with prediabetes is an unmet clinical need. Here, we examine the utility of subclinical myocardial necrosis assessed by high-sensitivity cardiac troponin T (hs-cTnT) in predicting health outcomes in stable subjects with prediabetes. Methods hs-cTnT was analyzed by a high-sensitivity assay (Roche 5th generation) in 2631 stable subjects with prediabetes (HbA1c 5.7–6.4% or fasting glucose 100–125\xa0mg/dL without previous diagnosis of diabetes or glucose-lowering therapy) who underwent elective coronary angiography for cardiac evaluation, and followed for major adverse cardiac events (MACE; death, myocardial infarction, stroke) over 3\xa0years and all-cause mortality over 5\xa0years. Results In our study cohort, hs-cTnT was highly prevalent with a median level of 13\xa0ng/L (interquartile range 8.2–21.6\xa0ng/L). Hs-cTnT was independently associated with incident MACE at 3\xa0years (Q4 vs. Q1 adjusted hazard ratio (HR) 2.42 [95% CI 1.69–3.46], P\u2009<\u20090.001) and 5-year mortality (adjusted HR 3.8 [95% CI 2.55–5.67], P\u2009<\u20090.001). This association remained significant in all subsets after adjustment for traditional risk factors and multiple factors known to increase hs-cTnT levels. Moreover, hs-cTnT independently predicted event risk in primary prevention subjects (n\u2009=\u2009557, HR 5.46 [95% CI 1.50–19.89), p\u2009<\u20090.01) for MACE; HR 9.53 [95% CI 2.08–43.73] for all-cause mortality) and secondary prevention subjects (n\u2009=\u20092074, HR 1.86 [95% CI 1.31–2.66], P\u2009<\u20090.001 for MACE; and 2.7 [95% CI 1.79–4.08), P\u2009<\u20090.001 for all-cause mortality). Conclusions In stable prediabetic subjects, the presence of subclinical myocardial necrosis as detected by hs-cTnT portends heightened long-term adverse cardiovascular event risk. Hs-cTnT levels may help to stratify risk and improve clinical decision making in patients with prediabetes. Trial registration ClinicalTrials.gov Identifier: NCT00590200.