Correlation of hs-troponin with Coronary Angiography Findings: Systematic Review

Abstract

Introduction: Coronary artery disease (CAD) remains a leading cause of global morbidity and mortality. Coronary angiography is considered the gold standard for evaluating coronary artery stenosis; however, its invasive nature limits widespread use. High-sensitivity cardiac troponin (hs-cTn) has emerged as a non-invasive biomarker capable of detecting minimal myocardial injury and may reflect the severity of coronary atherosclerosis. This systematic review aims to evaluate the relationship between hs-cTn levels and coronary angiography findings in patients with suspected or confirmed CAD. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive literature search was performed in PubMed, Scopus, Web of Science, and ScienceDirect databases for studies published between 2015 and 2025. Eligible studies included original research articles evaluating the association between hs-cTn levels (hs-cTnI or hs-cTnT) and coronary angiography findings, including stenosis severity, plaque burden, or angiographic scoring systems such as Gensini or SYNTAX scores. A total of 3,471 articles were identified, and 20 studies met the inclusion criteria and were analyzed qualitatively. Results and Conclusion: The majority of included studies demonstrated a significant positive association between hs-cTn levels and the presence, severity, and complexity of coronary artery disease. Elevated hs-cTn levels were consistently associated with higher degrees of coronary stenosis, increased plaque burden, and more complex coronary lesions. Several studies indicated that hs-cTnI may provide higher predictive value than hs-cTnT, while low-level elevations of hs-cTn were shown to reflect subclinical atherosclerosis and improve risk stratification. Overall, hs-cTn shows strong potential as a non-invasive biomarker for assessing CAD severity; however, heterogeneity in study populations, assay types, diagnostic criteria, and confounding factors necessitates cautious interpretation. Further standardized prospective studies are required to strengthen the clinical applicability of hs-cTn in predicting coronary angiographic severity.