Background: Elevated high-sensitivity cardiac troponin T (hs-cTNT) in stable coronary artery disease (CAD) was associated with cardiovascular death and heart failure. The relationship of hs-cTNT and coronary anatomical complexity was investigated in a previous cross-sectional study, however, there was no previous data in Thailand. The authors used Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score to represent coronary anatomical complexity.

Objective: To assess the correlation of hs-cTNT and coronary anatomical complexity represented by SYNTAX scores in stable CAD patients.

Materials and Methods: An hs-cTNT in stable patients undergoing pharmacological stress testing study had been previously conducted. The present single center prospective cohort study enrolled 250 consecutive patients with suspected CAD who underwent pharmacological stress magnetic resonance imaging (MRI) between January 2010 and November 2013. It demonstrated pattern of troponin release during pharmacological stress testing, which was different according to the ischemic burden. The present study enrolled the patients from the previous cohort, whose baseline hs-cTNT were taken before pharmacological stress test, and underwent coronary angiography (CAG) within six months. The authors excluded the patients with significant valvular heart disease, hypertrophic cardiomyopathy, pulmonary embolism, clinically significant pulmonary hypertension, CKD stage 4 to 5, left ventricular ejection fraction (LVEF) of less than 30%, and previous CABG. The patients admitted for acute chest pain or having dynamic EKG change at rest within 30 days before enrollment were also excluded.

Results: Correlation coefficient between SYNTAX and hs-cTNT is 0.403 (rs=0.09 to 0.64, p=0.013), which is a fair correlation. Using the hs-cTNT cutoff 5 ng/L, it had sensitivity of 80% and negative predictive value (NPV) of 80% to detect the high anatomical burden patients. The patients who were hospitalized due to angina had higher hs-cTNT of 17 versus 6 ng/L (p=0.032). Those who died had higher hs-cTNT of 25 versus 6 ng/L (p=0.012). All patients with hs-cTNT level lower than upper normal limit (13.5 ng/L) were alive at five years.

Conclusion: Hs-cTNT was fairly correlated with SYNTAX score and associated with worse clinical outcomes.

Keywords: High-sensitivity cardiac troponin T, SYNTAX score, Stable coronary artery disease