Key result
Initial hs-cTnT modestly discriminates obstructive CAD with an AUC of 0.64.
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Why the study?
The extent to which elevated or rising hs-cTnT values predict obstructive coronary artery disease in patients with NSTE-ACS referred for invasive coronary angiography is not well described.
Does high-sensitivity cardiac troponin T testing predict obstructive coronary artery disease in patients with NSTE-ACS referred for invasive coronary angiography?
Observational (n=728)
Yes
Does high-sensitivity cardiac troponin T testing predict obstructive coronary artery disease in patients with NSTE-ACS referred for invasive coronary angiography?
Effect estimate: AUC 0.64
p-value: p=<0.001
Elevated hs-cTnT alone has limited rule-in value for identifying obstructive CAD in NSTE-ACS patients, and serial changes provide no incremental diagnostic value.
Elevated hs-cTnT may flag obstructive CAD in NSTE-ACS; hypothesis-generating and should not yet change practice.
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.
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Khokhar et al. (2026) conducted an observational in NSTE-ACS (n=728). High-sensitivity cardiac troponin T (hs-cTnT) was evaluated on obstructive coronary artery disease (AUC 0.64, p=<0.001). Initial high-sensitivity cardiac troponin T levels modestly discriminated obstructive coronary artery disease (AUC 0.64), with higher levels in obstructive vs non-obstructive CAD (201.1 vs 78.8 ng/L).
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