Prognostic Impact of High-sensitive Troponin T Assessment in Elderly Patients with Chronic Heart Failure: Results from the CORONA Trial
Background—The incremental prognostic value of high-sensitive troponin T (hs-cTnT) in heart failure (HF) beyond that of hs-CRP and NT-proBNP is debated. We examined the prognostic value of hs-cTnT in a subgroup of patients from the CORONA study (Controlled Rosuvastatin Multinational Trial in HF).
Methods and Results—Hs-cTnT as a risk factor for the primary end-point (cardiovascular [CV] death, non-fatal myocardial infarction, non-fatal stroke; n=356), as well as all-cause mortality (n=366), CV mortality (n=299) and the composite of CV mortality and hospitalization from worsening of HF (n=465) was investigated in 1245 patients (≥60 years, New York Heart Association [NYHA] class II-IV, ischemic systolic HF) randomly assigned to 10mg rosuvastatin or placebo. In multivariable analyses, adjusting for left ventricular ejection fraction, NYHA class, age, body mass index, diabetes, sex, intermittent claudication, heart rate, estimated glomerular filtration rate, ApoB/ApoA-1-ratio, NT-proBNP and hs-CRP, hs-cTnT (both dichotomized according to the 99th-percentile and as a continuous variable) was associated with all end-points (primary end-point: HR 1.87 and 1.51, respectively, per standard deviation change, p<0.001; all other end-points: HR 1.39-1.70). However, improved discrimination as assessed by C-statistics was only seen for the primary end-point and all-cause mortality.
Conclusions—Elevated hs-cTnT levels provide strong and independent prognostic information in older patients with chronic ischemic HF.
Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00206310.
- Received March 19, 2013.
- Accepted November 13, 2013.