High population prevalence of cardiac troponin I measured by a high-sensitivity assay and cardiovascular risk estimation: The MORGAM Biomarker Project Scottish Cohort

Our aim was to test the prediction and clinical applicability of high-sensitivity assayed troponin I for incident cardiovascular events in a general middle-aged European population. Methods and results High-sensitivity assayed troponin Iwasmeasured in the Scottish HeartHealth ExtendedCohort (n = 15 340) with 2171 cardiovascular events (including acute coronary heart disease and probable ischaemic strokes), 714 coronary deaths (25% of all deaths),1980myocardial infarctions, and797strokesof all kindsduring anaverageof20years follow-up.Detectionrateabove the limitof detection (LoD)was 74.8% in theoverall populationand 82.6%inmenand 67.0% inwomen.Troponin I assayed by the high-sensitivity method was associated with future cardiovascular risk after full adjustment such as that individuals in the fourth category had 2.5 times the risk compared with those without detectable troponin I (P<0.0001). These associations remained significant even for those individuals in whom levels of contemporary-sensitivity troponin I measures were not detectable. Addition of troponin I levels to clinical variables led to significant increases in risk prediction with significant improvement of the c-statistic (P<0.0001) and net reclassification (P<0.0001). A threshold of 4.7 pg/mL in women and 7.0 pg/mL in men is suggested to detect individuals at high risk for future cardiovascular events. Conclusion Troponin I, measured with a high-sensitivity assay, is an independent predictor of cardiovascular events and might support selection of at risk individuals.