High Sensitivity Troponin Level and Benefits of Chronic Total Occlusion Revascularization

• Authors: Daniel Gold, Emory University; Pratik Sandesara, Emory University; Vardhmaan Jain, Emory University; Matthew Evan Gold, Emory University; Nishant Vatsa, Emory University; Shivang Rajan Desai, Emory University; Malika Elhage Hassan, Emory University; Chenyang Yuan, Emory University; Yi-An Ko, Emory University; Ayman Alkhoder, Emory University; Kiran Ejaz, Emory University; Zain Alvi, Emory University; Alireza Rahbar, Emory University; Gillian Murtagh, Abbott Laboratories; Wissam A. Jaber, Emory University; William Jay Nicholson, Emory University; Arshed Ali Quyyumi, Emory University
• Journal Title: Journal of the American Heart Association
• Volume: Volume 12, Number 21
• Publisher: Wiley | 2023-11-06, Pages e031431-None
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1161/JAHA.123.031431
• Subjects: Health Sciences, Public Health; Health Sciences, Epidemiology
• Keywords: chronic total occlusion; coronary artery bypass graft; high sensitivity troponin‐I; percutaneous coronary intervention; cardiology

Abstract

Background The survival benefit of revascularization of chronic total occlusion (CTO) of the coronary arteries remains a subject of controversy. We measured high sensitivity troponin‐I (hsTn‐I) levels as an estimate of myocardial ischemia in patients with stable coronary artery disease, with the hypothesis that (1) patients with CTO have higher levels of hsTn‐I than patients without CTO, (2) hsTn‐I levels will predict adverse cardiovascular events in patients with CTO, and (3) patients with elevated hsTn‐I levels will have a survival benefit from CTO revascularization. Methods and Results In 428 patients with stable coronary artery disease and CTO undergoing coronary angiography, adverse event rates were investigated. Cox proportional hazards models and Fine and Gray subdistribution hazard models were performed to determine the association between hsTn‐I level and incident event rates in patients with CTO. HsTn‐I levels were higher in patients with compared with those without CTO (median 6.7 versus 5.6 ng/L, P=0.002). An elevated hsTn‐I level was associated with higher adverse event rates (adjusted all‐cause mortality hazard ratio, 1.19 [95% CI, 1.08–1.32]; P=0.030) for every doubling of hsTn‐I level. CTO revascularization was performed in 28.3% of patients. In patients with a high (>median) hsTn‐I level, CTO revascularization was associated with substantially lower all‐cause mortality (adjusted hazard ratio, 0.26 [95% CI, 0.08–0.88]; P=0.030) compared with those who did not undergo revascularization. In patients with a low (<median) hsTn‐I level, event rates were similar in those with and without CTO revascularization. Conclusions HsTn‐I levels may help identify individuals who benefit from CTO revascularization.