Risk stratification of patients with prediabetes is an unmet clinical need. Here, we examine the utility of subclinical myocardial necrosis assessed by high-sensitivity cardiac troponin T (hs-cTnT) in predicting health outcomes in stable subjects with prediabetes. hs-cTnT was analyzed by a high-sensitivity assay (Roche 5th generation) in 2631 stable subjects with prediabetes (HbA1c 5.7–6.4% or fasting glucose 100–125 mg/dL without previous diagnosis of diabetes or glucose-lowering therapy) who underwent elective coronary angiography for cardiac evaluation, and followed for major adverse cardiac events (MACE; death, myocardial infarction, stroke) over 3 years and all-cause mortality over 5 years. In our study cohort, hs-cTnT was highly prevalent with a median level of 13 ng/L (interquartile range 8.2–21.6 ng/L). Hs-cTnT was independently associated with incident MACE at 3 years (Q4 vs. Q1 adjusted hazard ratio (HR) 2.42 [95% CI 1.69–3.46], P < 0.001) and 5-year mortality (adjusted HR 3.8 [95% CI 2.55–5.67], P < 0.001). This association remained significant in all subsets after adjustment for traditional risk factors and multiple factors known to increase hs-cTnT levels. Moreover, hs-cTnT independently predicted event risk in primary prevention subjects (n = 557, HR 5.46 [95% CI 1.50–19.89), p < 0.01) for MACE; HR 9.53 [95% CI 2.08–43.73] for all-cause mortality) and secondary prevention subjects (n = 2074, HR 1.86 [95% CI 1.31–2.66], P < 0.001 for MACE; and 2.7 [95% CI 1.79–4.08), P < 0.001 for all-cause mortality). In stable prediabetic subjects, the presence of subclinical myocardial necrosis as detected by hs-cTnT portends heightened long-term adverse cardiovascular event risk. Hs-cTnT levels may help to stratify risk and improve clinical decision making in patients with prediabetes. Trial registration ClinicalTrials.gov Identifier: NCT00590200.

中文翻译：

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高敏心肌肌钙蛋白 T 对糖尿病前期患者亚临床心肌坏死的预后价值

糖尿病前期患者的风险分层是未满足的临床需求。在这里，我们研究了通过高敏心肌肌钙蛋白 T (hs-cTnT) 评估的亚临床心肌坏死在预测稳定的前驱糖尿病患者健康结果中的效用。hs-cTnT 通过高灵敏度测定（罗氏第 5 代）对 2631 名稳定的前驱糖尿病受试者（HbA1c 5.7-6.4% 或空腹血糖 100-125 mg/dL，之前未诊断为糖尿病或降糖治疗）进行分析择期冠状动脉造影进行心脏评估，并随访 3 年以上的主要心脏不良事件（MACE；死亡、心肌梗塞、中风）和 5 年以上的全因死亡率。在我们的研究队列中，hs-cTnT 非常普遍，中位水平为 13 ng/L（四分位距 8.2-21.6 ng/L）。Hs-cTnT 与 3 年的 MACE 事件独立相关（Q4 与 Q1 调整后的风险比 (HR) 2.42 [95% CI 1.69–3.46]，P < 0.001）和 5 年死亡率（调整后的 HR 3.8 [95% CI 2.55–5.67]，P < 0.001）。在对传统风险因素和已知会增加 hs-cTnT 水平的多种因素进行调整后，这种关联在所有子集中仍然显着。此外，hs-cTnT 独立预测了 MACE 一级预防受试者的事件风险（n = 557，HR 5.46 [95% CI 1.50–19.89），p < 0.01）；HR 9.53 [95% CI 2.08–43.73] 全因死亡率）和二级预防受试者（n = 2074，HR 1.86 [95% CI 1.31–2.66]，MACE P < 0.001；和 2.7 [95% CI 1.79– 4.08），全因死亡率 P < 0.001）。在稳定的前驱糖尿病受试者中，hs-cTnT 检测到的亚临床心肌坏死的存在预示着长期心血管不良事件风险的增加。Hs-cTnT 水平可能有助于对糖尿病前期患者进行风险分层和改善临床决策。试验注册 ClinicalTrials.gov 标识符：NCT00590200。