Prevalence of obstructive coronary artery disease in asymptomatic cancer patients with elevated troponin levels

TL;DR

Elevated troponin in cancer patients often does not indicate heart blockage, with many cases linked to other factors like cancer treatments or non-cardiac conditions.

Contribution

This study identifies the low prevalence of obstructive coronary artery disease in cancer patients with elevated troponin and highlights the role of cancer therapies in cardiac injury.

Findings

Only 10% of cancer patients with elevated troponin had obstructive coronary artery disease.

Traditional cardiovascular risk factors were less predictive than expected, with cancer therapies playing a major role in cardiac injury.

67.6% of patients without obstructive CAD were undergoing active cancer treatments.

Abstract

High-sensitivity cardiac troponin T (hs-cTnT) is frequently elevated in cancer patients, but its clinical implications remain uncertain. We aimed to determine the prevalence of obstructive coronary artery disease (CAD) as a cause of hs-cTnT elevation and to evaluate the impact of cardiovascular risk factors and oncologic therapies.

Between 2016 and 2023, 810 consecutive cancer patients with elevated hs-cTnT values presenting to the cardio-oncology outpatient clinic in Heidelberg were included. All patients underwent standardized cardiovascular assessment. Further imaging or invasive evaluation was performed in cases of unexplained biomarker elevation. Logistic regression was applied to identify predictors of CAD. Oncologic therapies were categorized according to ESC cardio-oncology guidelines into low, moderate, or high cardiotoxic risk.

Overall, 340/810 (42.0%) patients revealed alternative explanations for hs-cTnT elevation (e.g., atrial fibrillation, pulmonary embolism, and renal dysfunction). Among the remaining 470/810 (58.0%) patients evaluated for suspected CAD, 47/470 (10.0%) underwent percutaneous coronary intervention for obstructive CAD, whereas 423/470 (90.0%) showed no indication for revascularization. In multivariable analyses, younger age, female sex, preserved left ventricular ejection fraction, and normal NT-proBNP levels were independently associated with the absence of obstructive CAD. Among the 423 patients without obstructive CAD, 286/423 (67.6%) received active oncologic therapy, and 78.3% were exposed to moderate- or high-risk cardiotoxic agents.

In cancer patients with elevated hs-cTnT, obstructive CAD is present in only a minority of cases. Traditional cardiovascular risk factors predict CAD, but therapy- and disease-related cardiac injury appear to be major contributors, highlighting the need for refined risk stratification.

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