Serial hs Troponin assessment may further refine risk-assessment in patients post ACS: JAMA study

An association between single measures of high-sensitivity troponin (hsTn) and future cardiovascular events in patients with chronic coronary syndromes have been shown previously. However, limited data exist regarding the association between changes in serial values of hsTn and subsequent cardiovascular events in this patient population. Addressing this lacunae, a recent study published in JAMA cardiology has shown the role of serial hsTnT assessment in future risk stratification of patients with established atherosclerosis. This may be useful to inform decision-making for therapies.

The present study is a secondary analysis of the IMPROVE-IT study which established that single measurements of hsTnT 1 month after stabilization post-ACS were associated with a risk of recurrent cardiovascular events.

In the current analysis of this cohort, authors Patel et al have evaluated whether serial assessment of hsTnT may further refine risk stratification. The current biomarker substudy includes the 6035 participants consenting to the biomarker substudy with available hsTnT at months 1 and 4.

The outcomes of interest were cardiovascular death, myocardial infarction (MI), stroke, or hospitalization for heart failure (HHF). Associations of absolute and relative changes in hsTnT between month 1 and month 4 as a function of the starting month 1 hsTnT and the composite outcome were examined using landmark analyses.

The study's main finding is that increases or decreases in hsTnT from month 1 to month 4 were associated with significantly higher or lower adjusted risk of cardiovascular events, respectively, across the range of starting month 1 hsTnT values.

Moreover, the magnitude of change in hsTnT was associated with a gradient of risk of cardiovascular events. Of all post-ACS patients, authors found that two-thirds had overall stable hsTnT concentration from month 1 to month 4 (absolute change of less than 3 ng/L).

For the remaining one-third with a dynamic change, the findings illustrate that the magnitude of risk associated with changes in hsTnT are proportionate to the overall magnitude of change from baseline, such that larger increases in hsTnT were associated with higher risk for subsequent events.

These findings suggest a role for the application of hsTnT for disease monitoring in patients with chronic coronary syndromes, where serial measures may be used to provide a continuous assessment of future cardiovascular risk.

Source: JAMA Cardiology: doi:10.1001/jamacardio.2022.3627