Prognostic Value of Cardiac Troponin T and Sex in Patients Undergoing Elective Percutaneous Coronary Intervention

Abstract

BackgroundIn patients with stable coronary artery disease undergoing elective percutaneous coronary intervention, the prognostic value of high‐sensitivity cardiac troponin T (hs‐cTnT) and the influence of sex remain poorly defined.Methods and ResultsConsecutive patients with stable coronary artery disease who underwent elective percutaneous coronary intervention were included. Primary endpoint was all‐cause mortality. Unadjusted hazard ratio (HR) in overall and sex‐specific population and multivariable adjusted HR were calculated by using Cox proportional hazard models. In a total of 5626 patients, elevated hs‐cTnT levels, more than the sex‐specific 99th percentile upper reference limit of normal (URL), were observed in 2221 patients (39%) at baseline. During follow‐up (median, 14.5 months; 25th–75th percentiles, 6.4–27.2 months), 265 patients died. Mortality was higher in patients with the sex‐specific 99th percentile URL compared to those with normal hs‐cTnT (17.3% vs 3.4%; HR=6.10; 95% CI, 4.58–8.14; P<0.001). hs‐cTnT was an independent predictor of mortality in multivariable adjusted models. The C‐statistic was significantly increased by adding hs‐cTnT to the basic prediction model for mortality (0.793–0.815; P<0.001). There was a significant interaction between hs‐cTnT and sex on mortality. Differences in all‐cause mortality between patients with more than the sex‐specific 99th percentile URL and those with normal hs‐cTnT were numerically larger in male than female patients (male, HR=6.45; 95% CI, 4.68–8.87, P<0.001; female, HR=4.29, 95% CI, 2.36–9.03; P<0.001).ConclusionsIn patients with stable coronary artery disease undergoing elective percutaneous coronary intervention, preprocedural hs‐cTnT was a strong predictor of mortality in both men and women.

Sexual Dimorphism in Cardiovascular Biomarkers: Clinical and Research Implications

“…In 5626 patients with stable CAD, preprocedural high-sensitivity cTnT was a strong predictor of mortality in both men and women, but the effect was particularly pronounced in men (HR 6.45 [95% CI, 4.68-8.87] in men versus HR 4.29 [95% CI, 2.36-9.03] in women). 56 This was seen again in a prospective study of patients with HFpEF, where cTnI was more strongly associated with adverse events in men versus women. 57 These findings were in contrast to other studies that demonstrated similar associations of cTnT concentration with adverse outcomes in men versus women.…”

Sex-Specific Thresholds for Cardiac Biomarkers—We Need to Move Forward

“…There are also abundant data showing that sex-specific cutoffs improve prognostication in patients with stable CAD and in primary prevention. In patients with stable coronary artery disease undergoing elective percutaneous coronary intervention, pre-procedural high-sensitivity cardiac troponin T (hs-cTnT) with the use of sex-specific cutoffs was proven to be a strong predictor of mortality in both males and females [ 21 ]. In an ancillary study of the BARI 2D trial [ 22 ], which evaluated a population of patients with diabetes and stable ischemic heart disease, lower concentrations of hs-cTnT observed in females were associated with an elevated risk of major cardiovascular (CV) events and death compared with males with similar hs-cTnT levels.…”