To assess whether troponin screening is associated with major adverse cardiovascular events (MACEs) in patients undergoing immune checkpoint inhibitor (ICI) therapy.
Approach:
Study Design: A multicenter retrospective cohort study comparing outcomes of patients undergoing systematic troponin screening with those undergoing clinical assessment alone.
Patient Population: Adult patients treated with ICIs for solid cancer from January 1, 2017, to December 31, 2022, at Institut Montsouris and Institut Curie in France.
Outcome Measures: Major adverse cardiovascular events (MACEs) including ICI-associated myocarditis, acute coronary syndrome (ACS), heart failure requiring hospital admission, cardiovascular death, and sudden cardiac death (SCD).
Statistical Analysis: Used competitive risk and propensity score-matched analysis to mitigate confounders.
Key Findings:
Troponin screening may lead to increased referrals for suspected cardiovascular events during ICI treatment.
Troponin levels can be elevated in various clinical scenarios, complicating the specificity for detecting ICI-associated myocarditis.
The incidence of ICI-associated myocarditis is approximately 1%, making it a rare complication.
Interpretation:
The study assesses the relationship between troponin screening and cardiovascular events in ICI-treated patients, focusing on the potential for unnecessary treatment interruptions due to elevated troponin levels.
Limitations:
The study is retrospective and may be subject to biases inherent in observational studies.
Troponin assays and thresholds varied, affecting generalizability.
The study did not include patients in double-blinded randomized clinical trials.
Conclusion:
The findings indicate the need for careful consideration of troponin screening in ICI therapy.
