Predictors of high-sensitivity cardiac troponin in stable patients undergoing coronary angiography

Abstract

Aims: Elevated levels of high-sensitivity troponin are seen in a significant proportion of stable patients undergoing elective coronary assessment. Multiple variables have been associated with troponin levels. The present analysis sought to identify variables independently associated with elevations of troponin and their relative strength of association with this biomarker. Methods and results: Stable patients undergoing elective coronary angiography and echocardiographic assessment were enrolled. High-sensitivity troponin T (hsTnT) was determined before any diagnostic procedures. Multivariable linear regression models including angiographic and echocardiographic parameters were used to identify independent predictors of levels of troponin and to determine their relative contribution to levels of troponin. Out of 2,046 patients, 15% presented with levels of troponin above the upper reference limit of normal. In a combined analysis, gender followed by renal function, age, left ventricular ejection fraction, diabetes, and left ventricular mass showed the strongest association with levels of troponin. Coronary obstruction was also an independent predictor, but strength of association weakened following adjustment. Conclusions: Up to 15% of patients undergoing coronary assessment outside the setting of acute coronary syndromes present with elevated levels of cardiac troponin. These changes are independently associated with multiple clinical, laboratory, and imaging variables.