https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Hamburg-Eppendorf Klinik für Kardiologie Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Klinik und Poliklinik für Kardiologie Hamburg, Deutschland; 3Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 4Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland
Methods: Patients undergoing cardiac stress testing for suspected coronary artery dis-ease were recruited in a prospective cohort study. Measurements of high-sensitivity cardiac troponin (hs-cTnI), high-sensitivity C-reactive protein (hs-CRP), and natriuretic peptides (NT-proBNP) were obtained before the stress test. Hs-cTnI concentrations were also measured one hour after the stress test. The diagnostic performance of each biomarker in predicting a pathological stress test was evaluated by calculating the area under the receiver operating characteristic curve. Cox regression analysis was conduct-ed to identify predictors of incident major adverse cardiovascular events (MACE).
Results: 778 participants (median age 70 years) were included in the final analysis, of which 240 had a pathological stress test and 558 a non-pathological stress test. During follow-up of 33 months (IQR 32-34), an event rate of 17.8 % was reported for MACE. Baseline hs-cTnI and NT-proBNP concentrations were significantly higher in participants with a pathological stress test (8.0 ng/L vs. 4.5 ng/L and 398.9 vs. 261.6 ng/L, respective-ly). Hs-cTnI concentrations after one hour showed a slight decrease from the baseline concentration.
All biomarker concentrations showed poor performance in discriminating between pathological and non-pathological stress tests. Concentrations of hs-cTnI and NT-proBNP were significantly associated with incident MACE after adjusting for conventional cardiovascular risk factors (HR 1.29 per SD [95% CI 1.15, 1.45] and 1.19 per SD [95%CI 1.07, 1.32] respectively)
Conclusion: In patients undergoing cardiac stress testing, concentrations of hs-cTnI, NT-proBNP, and hs-CRP demonstrated limited ability in discriminating between pathological and non-pathological test results. However, hs-cTnI and NT-proBNP concentrations were predictors of incident MACE beyond established cardiovascular risk factors sug-gesting their potential to improve cardiovascular risk assessment in high-risk popula-tions.