# High Sensitivity Cardiac Troponin T Versus Cardiac Troponin I on Prediction of Significant Coronary Artery Disease in Patients Hospitalized Due to Symptomatic Atrial Fibrillation

## TL;DR

This study shows that high-sensitivity cardiac troponin T (hs-cTnT) is better than cardiac troponin I (cTnI) at predicting significant coronary artery disease in patients with atrial fibrillation.

## Contribution

The study demonstrates the superior predictive value of hs-cTnT over cTnI for detecting significant CAD in hospitalized atrial fibrillation patients.

## Key findings

- hs-cTnT had 100% sensitivity for detecting CAD requiring intervention, compared to 62.5% for cTnI.
- A regression model including age, history of CAD, and hs-cTnT achieved an AUC of 0.83, showing strong pretest performance.
- Higher hs-cTnT levels were significantly associated with the need for revascularization in AF patients.

## Abstract

Background/Objectives: Patients with atrial fibrillation (AF) often have symptoms and risk factors similar to those of patients with coronary artery disease (CAD). However, the clinical criteria for identifying AF patients who would benefit from coronary angiography (CA) remain vague. We evaluated the predictive value of cardiac troponin I (cTnI), high-sensitivity cardiac troponin T (hs-cTnT), and various clinical parameters for detecting significant coronary artery stenosis. Methods: We retrospectively analyzed symptomatic AF patients admitted to the University Hospital Bonn emergency department between 2015 and 2019 undergoing CA. Out of 183 AF patients, 93 were screened with cTnI and 90 with hs-cTnT. Results: A total of 47 out of 183 (26%) AF patients were diagnosed with significant coronary artery stenosis. The sensitivity for detecting CAD requiring intervention was 62.5% [95% CI, 40.6–81.2%] for cTnI and 100% [95% CI, 85.2–100%] for hs-cTnT. Median hs-cTnT concentrations were significantly higher in the “Revascularization-group” than in the “Non-Revascularization-group” (30.05 ng/L [95% CI, 26.5–54.8 ng/L], 23 patients vs. 15.3 ng/L [95% CI, 12.7–22.5 ng/L], 67 patients, p < 0.001). The calculated regression model that includes age, history of CAD, and hs-cTnT showed the best pretest performance with an AUC of 0.83, p = 0.008. Poor performance was observed for cTnI (AUC of 0.63, p = 0.098). Conclusions: This study demonstrates that the hs-cTnT assay is superior to the contemporary cTnI assay in predicting significant CAD requiring revascularization in patients hospitalized with AF. Older age, pre-existing CAD, impaired renal function, and a higher hs-cTnT cut-off showed the highest pretest probability of relevant CAD in patients hospitalized for AF.