Cardiac troponins predict adverse clinical outcomes in stable coronary artery disease: a dose-response meta-analysis of prospective studies.

Background: Predictive value of cardiac tropnins (cTns) in stable coronary artery disease (SCAD) has not been fully investigated. Methods: We performed a meta-analysis to evaluate the dose-response relationship between serum detectable/rising cTns and adverse clinical outcomes, including all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), heart failure (HF) or major adverse cardiovascular events (MACEs) in SCAD. Results: Sixteen studies involved 34,854 subjects were included. Compared with patients with negative/undetectable cTns, those with rising/detectable cTns were associated with increased risk of all-cause mortality, CV mortality, MI, HF and MACEs [the hazard ratio (HR) was 1.83 (95% confidence interval (CI) 1.61-2.08), 2.11 (1.80-2.48), 1.43 (1.26-1.62), 2.36 (1.97-2.83) and 1.99 (1.57-2.53), respectively]. Dose-response analysis have revealed that per 1-SD increment of cTnT was associated with increased risk of all-cause mortality, CV mortality, MI, HF and MACEs [the HR was 1.78 (1.20-2.63), 1.62 (1.41-1.85), 1.26 (1.12-1.42), 1.78 (1.17-2.69) and 1.26 (1.00-1.59), respectively]. Conclusion: Rising/detectable cTns was associated with increased risk of all-cause mortality, CV mortality, MI, HF and MACEs in SCAD in a dose-response manner.