Differential prognostic value of high-sensitivity troponin T based on renal function status: insights from 14,208 ACS...

High-sensitivity troponin T (hsTnT) is a standard biomarker for myocardial injury detection, but its prognostic value may differ by renal function status. This study evaluated how renal function modifies the prognostic significance of hsTnT in ACS patients undergoing PCI.

This study examined 14,208 acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI), stratified by renal function [estimated glomerular filtration rate (eGFR) < 60 vs. ≥60 mL/min/1.73 m²] and peak hsTnT levels [<5× vs. ≥5× upper reference limit (URL)]. Primary outcomes included one-year all-cause mortality and one-year incidence of ischemic events following the index PCI procedure.

In patients with impaired renal function, elevated hsTnT was associated with significantly increased mortality [12.84% vs. 4.29%; adjusted hazard ratio [HR] 3.63, 95% confidence interval [CI] 2.04-6.49, P < 0.0001] and ischemic events (10.66% vs. 4.88%; adjusted HR: 2.72, 95% CI: 1.51-4.88, P = 0.0008). In patients with preserved renal function, the mortality association was attenuated (1.42% vs. 0.98%; adjusted HR: 1.40, 95% CI: 0.85-2.29, P = 0.1864), although ischemic events remained significantly increased (2.93% vs. 1.54%; adjusted HR: 2.06, 95% CI: 1.41-2.97, P = 0.0002). Restricted cubic spline analysis revealed a significant non-linear relationship between hsTnT levels and mortality specifically in impaired renal function cohort (P for non-linearity = 0.0004), whereas a predominantly linear association was observed in patients with preserved renal function. A significant interaction was observed between renal function and hsTnT for mortality prediction (P for interaction = 0.0089).

These findings indicate that renal function substantially modifies the prognostic significance of hsTnT among ACS patients post-PCI. Integrating renal function and peak hsTnT into risk assessment may help identify high-risk subgroups requiring intensified follow-up and management.