Troponin to detect major cardiovascular adverse events on immune checkpoint inhibitors : a propensity matched multicentre retrospective study

Troponin monitoring is recommended for the early detection of immune checkpoint inhibitor (ICI)–associated myocarditis, but its utility as an universal screening tool for all cardiovascular (CV) toxicities in ICI recipients remains uncertain.

To evaluate whether systematic troponin screening is associated with reduced major adverse cardiovascular events (MACE) and mortality in patients receiving ICI therapy.

The TILT study was a retrospective, multicentre cohort of 859 adults treated with ICI between 2017 and 2022 at two tertiary oncology centres. Patients undergoing systematic troponin surveillance (≥2 measurements during the first trimester of ICI therapy not prompted by symptoms) were compared with those without screening. Outcomes included adjudicated MACE (ICI-myocarditis, acute coronary syndrome, heart failure requiring hospitalization, sudden cardiac death, CV death). Multivariable Cox regression, Fine–Gray competing risk models, and propensity score matching were applied, with cancer death considered a competing risk.

Of 859 patients (mean age 70±11 years, 60% male, 68% lung cancer), 40 (4.7%) developed MACE, including 6 (0.7%) ICI-myocarditis; 484 (56.3 %) patients died at median FU of 3.3 months (IQR 1.3-7.2), mainly (90.1%) from cancer. Troponin surveillance was not significantly associated with MACE (HR 0.56, 95% CI 0.20–1.55, P=0.27) after competitive risk analysis (Fine-Gray); or in a propensity-matched cohort of 354 patients (HR 0.49 (95% CI (0.20-1.24), P=0.13).

Systematic troponin screening was not associated with MACE in a severe cancer population after risk competitive analysis or after propensity score matching. These findings question the benefit of universal troponin monitoring in unselected cancer populations receiving ICIs.

MACE in the study population