The following is a summary of “High Sensitivity Troponin Level and Benefits of Chronic Total Occlusion Revascularization,” published in the November 2023 issue of Cardiology by Gold et al.

The contentious survival benefits of revascularizing chronic total occlusions (CTOs) in coronary arteries prompted their investigation using high-sensitivity troponin‐I (hsTn‐I) as an indicator of myocardial ischemia among stable coronary artery disease patients. Their hypotheses were threefold: Patients with CTOs exhibit higher hsTn‐I levels compared to those without CTOs, elevated hsTn‐I levels predict adverse cardiovascular events in CTO patients, and individuals with elevated hsTn‐I levels gain survival advantages from CTO revascularization. In their study encompassing 428 stable coronary artery disease patients with CTOs undergoing coronary angiography, the researchers scrutinized adverse event rates. Their analysis utilizing Cox proportional hazards models and Fine and Gray subdistribution hazard models revealed higher hsTn‐I levels in CTO patients versus those without (median 6.7 versus 5.6 ng/L, P=0.002). 

Elevated hsTn‐I levels correlated with escalated adverse event rates (adjusted all‐cause mortality hazard ratio, 1.19 [95% CI, 1.08–1.32]; P=0.030) for every doubling of hsTn‐I level. CTO revascularization was undertaken in 28.3% of patients. For individuals exhibiting a high (>median) hsTn‐I level, CTO revascularization markedly reduced all‐cause mortality (adjusted hazard ratio, 0.26 [95% CI, 0.08–0.88]; P=0.030) compared to non-revascularized counterparts. However, event rates remained similar in patients with low (<median) hsTn‐I levels, regardless of CTO revascularization.

The findings suggest that hsTn‐I levels can potentially serve as a marker to identify individuals who might benefit from CTO revascularization.

Source: ahajournals.org/doi/10.1161/JAHA.123.031431