The predictive value of baseline troponin measurements in patients treated with immune checkpoint inhibitors

Background: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but are associated with immune-related adverse events (irAEs), including potentially life-threatening cardiovascular (CV) complications. Despite guideline recommendations for baseline troponin monitoring, the predictive value of high-sensitivity troponin I (hs-TnI) remains underexplored.
Objective: To evaluate the predictive value of baseline hs-TnI for clinical outcomes in patients treated with ICIs.
Methods: A retrospective, single-center, observational study including patients treated with ICIs and performing baseline hs-TnI measurements. A hs-TnI level > 50ng/L was considered abnormal, adopted by Siemens recommendations cutoff. The primary endpoint was all-cause mortality, and the secondary endpoint was CV irAEs, defined as the composite of myocarditis, pericarditis, acute coronary syndrome, heart failure, or arrhythmias.
Results: The cohort included 621 patients, with a mean age of 69±12 years, and was predominantly male (64%). Lung cancer was the most common malignancy (20%), and pembrolizumab (anti-PD-1) was the most frequently used ICIs (65%). Baseline cardiovascular (CV) risk factors were common, including hypertension (48%), diabetes mellitus (24%), and hyperlipidemia (38%), while ischemic heart disease was present in 22% of patients. Thirty-three patients (5%) presented with abnormal baseline hs-TnI. Abnormal hs-TnI was significantly associated with increased all-cause mortality (adjusted HR 1.651 [95% CI = 1.080-2.525], p = 0.021) and increased incidence of CV irAEs (adjusted HR 2.825 [95% CI = 1.273-6.272], p = 0.011).
Conclusions: Baseline hs-TnI emerged as a significant independent predictor for all-cause mortality and CV irAEs in patients treated with ICIs. These findings highlight the clinical utility of routine baseline hs-TnI monitoring for early risk stratification. Prospective, multicenter studies are warranted to validate these results and optimize CV monitoring strategies in this population.