Prevalence of obstructive coronary artery disease in asymptomatic cancer patients with elevated high-sensitivity troponin T

Background Elevated high-sensitivity troponin T (hs-cTnT) levels are frequently observed in cancer patients, yet their clinical significance often remains unclear. In particular, the prevalence of obstructive coronary artery disease (CAD) as an underlying cause is insufficiently defined. Methods In this single-center cohort study, 810 asymptomatic cancer patients with elevated hs-cTnT presenting to a cardio-oncology clinic between 2016 and 2023 were analyzed. All patients underwent a prospective structured cardiovascular assessment including clinical evaluation, echocardiography, and biomarker analysis at standardized follow-up appointments. In cases of unexplained troponin elevation, systematic diagnostic work-up for obstructive CAD was performed. Predictors of the presence or absence of obstructive CAD were analyzed using logistic regression. Oncologic therapies were classified according to ESC guidelines regarding cardiotoxic risk. Results Among 810 patients, 470 (58.0%) underwent further evaluation for suspected CAD due to unexplained hs-cTnT elevation. Of these, 47 patients (10.0%) had a relevant obstructive CAD requiring PCI, whereas 90.0% showed no significant coronary stenosis. Independent predictors of the absence of relevant CAD included younger age, female sex, normal NT-proBNP levels, and preserved left ventricular ejection fraction. Notably, 78.3% of patients without obstructive CAD were receiving oncologic therapies associated with moderate or high cardiotoxic risk. Conclusions In asymptomatic cancer patients, elevated hs-cTnT is not consistently driven by obstructive CAD. While elevated hs-cTnT levels associated with a worthened outcome, non-ischemic causes, including therapy- or tumor-related myocardial injury, appear to predominate. These findings highlight the need for individualized risk stratification and careful interpretation of cardiac biomarkers in oncology patients.