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Background

Cardiac troponin concentrations are used to identify patients who would benefit from urgent
revascularization for acute coronary syndromes. We hypothesized that they might be used in patients
with stable ischemic heart disease to identify those at high risk for cardiovascular events who might also
benefit from prompt coronary revascularization.

METHODS

We measured the cardiac troponin T concentration at baseline with a high-sensitivity assay in 2285
patients who had both type 2 diabetes and stable ischemic heart disease and were enrolled in the
Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes trial. We tested for an association
between the troponin T concentration and a composite end point of death from cardiovascular causes,
myocardial infarction, or stroke; we then evaluated whether random assignment to prompt
revascularization reduced the rate of the composite end point in patients with an abnormal troponin T
concentration (14 ng per liter) as compared with those with a normal troponin T concentration (<14 ng
per liter).

RESULTS

Of the 2285 patients, 2277 (99.6%) had detectable (3 ng per liter) troponin T concentrations and 897
(39.3%) had abnormal troponin T concentrations at baseline. The 5-year rate of the composite end point
was 27.1% among the patients who had had abnormal troponin T concentrations at baseline, as
compared with 12.9% among those who had had normal baseline troponin T concentrations. In models
that were adjusted for cardiovascular risk factors, severity of diabetes, electrocardiographic
abnormalities, and coronary anatomy, the hazard ratio for the composite end point among patients with
abnormal troponin T concentrations was 1.85 (95% confidence interval [CI], 1.48 to 2.32; P<0.001).
Among patients with abnormal troponin T concentrations, random assignment to prompt
revascularization, as compared with medical therapy alone, did not result in a significant reduction in
the rate of the composite end point (hazard ratio, 0.96; 95% CI, 0.74 to 1.25).

CONCLUSIONS

The cardiac troponin T concentration was an independent predictor of death from cardiovascular
causes, myocardial infarction, or stroke in patients who had both type 2 diabetes and stable ischemic
heart disease. An abnormal troponin T value of 14 ng per liter or higher did not identify a subgroup of
patients who benefited from random assignment to prompt coronary revascularization.

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