OBJECTIVES The goal of this study was to examine associations between concentrations of high-sensitivity troponin I (hsTnI) (measured by using a single-molecule counting method) and obstructive coronary artery disease (CAD) in 1,844 stable, symptomatic outpatients with suspected CAD randomized to undergo coronary computed tomography angiography (CTA) in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial. BACKGROUND Elevated concentrations of hsTnI are associated with CAD in patients with myocardial infarction. The meaning of hsTnI concentrations in stable symptomatic outpatients is not well understood. METHODS Clinical characteristics and CTA results (including coronary artery calcium [CAC] scores) were expressed across hsTnI quartiles. Determinants of hsTnI concentration were identified. Multivariable logistic regression identified independent predictors of obstructive CAD50 (≥50% stenosis in any vessel) and CAD70 (≥70% stenosis or ≥50% left main). RESULTS The median hsTnI concentration was 1.5 ng/l; nearly all (98.5%) subjects had measurable hsTnI, and 6.1% had concentrations ≥99th percentile concentration for this assay (6 ng/l). Higher CAC scores, as well as more prevalent and diffuse CAD, was seen in upper hsTnI quartiles (all p < 0.001). Independent predictors of hsTnI concentrations included age, sex, and CAC score (all p < 0.05). After adjusting for demographic and clinical characteristics, log-transformed hsTnI concentrations were associated with obstructive CAD50 (odds ratio: 1.15 per interquartile range; p = 0.02) and CAD70 (odds ratio: 1.25 per interquartile range; p = 0.001). CONCLUSIONS In stable symptomatic outpatients undergoing nonemergent coronary CTA for the diagnosis of suspected CAD, higher concentrations of hsTnI were associated with increasing presence and severity of coronary atherosclerosis. (Prospective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550).

中文翻译：

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疑似CAD的有症状门诊患者的高敏感性肌钙蛋白I和冠状动脉计算机断层扫描：PROMISE试验的见解。

目的本研究的目的是在1,844名稳定，有症状的疑似CAD患者中对高敏感性肌钙蛋白I（hsTnI）（通过单分子计数法测量）和阻塞性冠状动脉疾病（CAD）的浓度之间的相关性进行研究。在PROMISE（评估胸痛的前瞻性多中心影像研究）试验中接受冠状动脉计算机断层造影血管造影（CTA）。背景技术心肌梗死患者中hsTnI的升高与CAD相关。稳定的有症状门诊患者中hsTnI浓度的含义尚不清楚。方法在hsTnI四分位数中表达临床特征和CTA结果（包括冠状动脉钙化[CAC]评分）。确定了hsTnI浓度的决定因素。多变量logistic回归确定了阻塞性CAD50（任何血管中≥50％狭窄）和CAD70（≥70％狭窄或≥50％左主干）的独立预测因子。结果hsTnI的中位数浓度为1.5 ng / l。几乎所有受试者（98.5％）均具有可测量的hsTnI，而该试验中6.1％的受试者的浓度≥99％（6 ng / l）。在较高的hsTnI四分位数中，观察到较高的CAC评分以及更普遍和弥漫的CAD（所有p <0.001）。hsTnI浓度的独立预测因子包括年龄，性别和CAC评分（所有p <0.05）。在调整了人口统计学和临床​​特征后，对数转换后的hsTnI浓度与阻塞性CAD50（比值：每个四分位间距1.15； p = 0.02）和CAD70（比值：每个四分位间距1.25； p = 0.001）相关。结论在接受非合并冠状动脉CTA诊断的可疑CAD的稳定症状患者中，高浓度的hsTnI与冠状动脉粥样硬化的存在和严重程度增加有关。（用于评估胸痛[PROMISE]的前瞻性多中心成像研究； NCT01174550）。