Cardiovasc Revasc Med. 2026 May 23:S1553-8389(26)00201-0. doi: 10.1016/j.carrev.2026.05.007. Online ahead of print.
ABSTRACT
BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) is widely used for risk stratification in patients presenting with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS). However, the extent to which elevated or rising hs-cTnT values predict obstructive coronary artery disease (CAD) in patients referred for invasive coronary angiography (ICA) is not well described.
METHODS: We performed a retrospective analysis of consecutive patients with NSTE-ACS across a large multi-hospital health system who underwent hs-cTnT testing and ICA during the same episode of care. Clinical characteristics, hs-cTnT measurements, and noninvasive and invasive diagnostic findings were evaluated. The association between hs-cTnT values and obstructive CAD was assessed using logistic regression and receiver-operating characteristic (ROC) analysis.
RESULTS: Among 728 patients with elevated hs-cTnT, obstructive CAD was identified in 413 (57%), whereas 312 (43%) had non-obstructive coronary artery disease. Initial hs-cTnT levels were significantly higher in patients with obstructive CAD compared with those without (201.1 ± 449.9 ng/L vs. 78.8 ± 189.6 ng/L; p < 0.001). In contrast, 1-hour and 3-hour delta hs-cTnT values were not associated with obstructive CAD. The initial hs-cTnT demonstrated modest discrimination for obstructive CAD (AUC 0.64), with sex-specific optimal thresholds of 64 ng/L for females and 48 ng/L for males. Model performance improved (AUC 0.72) when adjusted for demographic and cardiovascular risk factors.
CONCLUSION: In patients with NSTE-ACS referred for ICA, elevated hs-cTnT alone has limited "rule-in" value for identifying obstructive CAD. Initial hs-cTnT levels modestly predicted obstructive CAD, whereas serial hs-cTnT changes provided no incremental diagnostic value. Incorporating demographic and clinical risk factors significantly improved the identification of obstructive CAD in this population.
PMID:42230218 | DOI:10.1016/j.carrev.2026.05.007