Abstract | Background: Many patients with coronary artery disease (CAD) are routinely referred for surveillance stress testing despite recommendations against it. Objective: To determine whether low levels of resting high-sensitivity cardiac troponin I (hs-cTnI) can identify persons without inducible myocardial ischemia. Design: Observational study. Setting: A university-affiliated hospital network. Patients: Persons with stable CAD: 589 in the derivation group and 118 in the validation cohort. Measurements: Presence of inducible myocardial ischemia was determined by myocardial perfusion imaging with technetium-99m single-photon emission computed tomography during either treadmill or pharmacologic stress testing. Resting plasma hs-cTnI was measured within 1 week of the stress test, and the negative predictive value (NPV) for inducible ischemia was calculated. The derivation cohort was followed for 3 years for incident cardiovascular death and myocardial infarction. Results: In the derivation cohort, 10 of 101 patients with an hs-cTnI level below 2.5 pg/mL had inducible myocardial ischemia (NPV, 90% [95% CI, 83% to 95%]) and 3 of 101 had inducible ischemia involving at least 10% of the myocardium (NPV, 97% [CI, 92% to 99%]). In the validation cohort, 4 of 32 patients with an hs-cTnI level below 2.5 pg/mL had inducible ischemia (NPV, 88% [CI, 71% to 96%]) and 2 of 32 had ischemia of 10% or greater (NPV, 94% [CI, 79% to 99%]). After a median follow-up of 3 years in the derivation cohort, no adverse events occurred in patients with an hs-cTnI level below 2.5 pg/mL, compared with 33 (7%) cardiovascular deaths or incident myocardial infarctions among those with an hs-cTnI level of 2.5 pg/mL or greater. Limitation: The data may not be applicable to a population without known CAD or to persons with unstable angina, and the modest sample sizes warrant further validation in a larger cohort. Conclusion: Very low hs-cTnI levels may be useful in excluding inducible myocardial ischemia in patients with stable CAD. Primary Funding Source: National Institutes of Health.
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Authors | Muhammad Hammadah, Jeong Hwan Kim, Ayman Samman Tahhan, Bryan Kindya, Chang Liu, Yi-An Ko, Ibhar Al Mheid, Kobina Wilmot, Ronnie Ramadan, Ayman Alkhoder, Fahad Choudhary, Mohamad Mazen Gafeer, Naser Abdelhadi, Pratik Pimple, Pratik Sandesara, Bruno B Lima, Amit J Shah, Laura Ward, Michael Kutner, J Douglas Bremner, David S Sheps, Paolo Raggi, Laurence S Sperling, Viola Vaccarino, Arshed A Quyyumi |
Journal | Annals of internal medicine
(Ann Intern Med)
Vol. 169
Issue 11
Pg. 751-760
(12 04 2018)
ISSN: 1539-3704 [Electronic] United States |
PMID | 30398528
(Publication Type: Journal Article, Observational Study, Research Support, N.I.H., Extramural)
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Chemical References |
- Biomarkers
- Radiopharmaceuticals
- Troponin I
- Technetium
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Topics |
- Aged
- Biomarkers
(blood)
- Exercise Test
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Myocardial Ischemia
(diagnosis, diagnostic imaging)
- Myocardial Perfusion Imaging
- Predictive Value of Tests
- Radiopharmaceuticals
- Technetium
- Tomography, Emission-Computed, Single-Photon
- Troponin I
(blood)
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