The Prognostic Value of High-Sensitivity Cardiac Troponin in Stable Coronary Artery Disease: A Systematic Review and Meta-analysis

Background: High-sensitivity cardiac troponin (hs-cTn) assays can detect myocardial injury at significantly lower concentrations than conventional assays. While the diagnostic and prognostic value of hs-cTn in acute coronary syndromes is well-established, its prognostic significance in stable coronary artery disease (CAD) remains less defined. This systematic review and meta-analysis aimed to evaluate the prognostic value of hs-cTn for adverse outcomes in patients with stable CAD. Matrial and Methods: We conducted a systematic search of PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science from inception to May 2025. Studies reporting the association between baseline hs-cTn levels and clinical outcomes in stable CAD patients were included. The primary outcomes were all-cause mortality and major adverse cardiovascular events (MACE). Random-effects meta-analysis was performed to calculate pooled hazard ratios (HRs) with 95% confidence intervals (CIs). Results: Ten studies comprising 14,938 patients with stable CAD were included in the quantitative analysis. Elevated hs-cTn levels were significantly associated with increased risk of all-cause mortality (pooled HR: 1.50, 95% CI: 1.43-1.57, I² = 24.0%) and cardiovascular events (pooled HR: 1.44, 95% CI: 1.38-1.51, I² = 50.8%). The prognostic value remained consistent across different hs-cTn assays (T and I) and was independent of traditional risk factors, renal function, and left ventricular ejection fraction. A troponin ratio >0.24 (relative to the 99th percentile upper reference limit) identified over 50% of patients at risk for death and heart failure hospitalization. Conclusions: Elevated hs-cTn levels are independently associated with increased risk of mortality and cardiovascular events in patients with stable CAD. Incorporating hs-cTn measurement into risk stratification algorithms may improve prognostic assessment in this population. Future research should focus on establishing optimal cutoff values and determining whether hs-cTn-guided management strategies can improve outcomes.