QUEBEC CITY — Preoperative elevated troponin levels were associated with a more than fourfold increased risk for major cardiovascular events (MACE) among patients with end-stage kidney disease (ESKD) in the year following renal transplantation, according to a retrospective cohort study presented at the Canadian Cardiovascular Congress (CCC) 2025.

Myocardial injury after noncardiac surgery was defined as any troponin elevation above the 99th percentile within 30 days of surgery. Even when the injury is clinically silent, this biomarker has been shown to predict MACE and death, most notably in the VISION trial.

Although troponin levels can predict the risk for a cardiovascular event following noncardiac surgery, a patient with kidney disease may already have high troponin levels, Ludovic Mouttet, PhD candidate in surgical and interventional sciences at McGill University in Montreal, told Medscape Medical News. Mouttet chaired the session but was not involved in the study.

“The question becomes,” he said, “how do you predict if you’re going to have a risk of a cardiovascular event after receiving the kidney transplant if your troponin is already high?” 

To find out, Arya Ardehali, medical student at the University of British Columbia in Vancouver, and colleagues examined whether pretransplant troponin levels predicted 1-year MACE following kidney transplantation in patients with ESKD.

For the single tertiary center retrospective cohort study, 261 consecutive patients with ESKD referred for pretransplant cardiac assessment between 2013 and 2024 were identified. Of these patients, 153 (59%) ultimately underwent transplantation, and 136 met inclusion criteria for the study.

Elevated baseline troponin levels were present in 93 of the 136 patients (68%). Notably, pretransplant patient demographics and comorbidities were similar between the groups with and without preoperative elevated troponin levels: age at transplantation (61 and 59 years), presence of coronary artery disease (62.4% and 46.5%), past myocardial infarction (22.6% and 23.3%), prior revascularization (39.8% and 32.6%), heart failure (30.1% and 20.9%), and mean left ventricular ejection fraction (58% and 60%, respectively).

Among the 136 patients who underwent transplantation, 24 (18%) experienced MACE within a year after transplantation. MACE occurred more frequently among those with vs without elevated troponin at baseline (22.6% vs 7.0%).

In addition, troponin levels were significantly higher among those who did vs did not develop MACE, at 4.2-fold vs 3.2-fold of the upper reference limit of the assay.

Overall, elevated troponin at baseline was associated with a nearly fourfold increased risk for MACE (odds ratio, 3.9).

“Amongst ESKD patients with cardiovascular disease, elevated baseline troponins were predictive of MACE in the year following kidney transplant,” said Ardehali. “It’s exciting for us because it provides us with more concrete indicators of post-transplant risk that we can hopefully use in the clinic” when stratifying candidates for kidney transplant on the basis of cardiac risk. 

Limitations of the analysis, pointed out by Ardehali, include the fact that it was a single-center study with a limited number of MACE cases, entailed potential selection bias as only patients referred for cardiac evaluation were included, and had a short duration of follow-up.

Troponin could perhaps be a faster way of looking at cardiovascular risk, “instead of doing echocardiograms and stress tests, which are quite time consuming,” agreed Mouttet. “If the predictive value of troponin were to be validated in larger, multicenter, ideally multinational, prospective cohorts of patients with ESKD, it could indeed become a useful indicator of cardiovascular risk, likely in combination with other biomarkers.”

Next, Ardehali and his team will explore this question in larger studies with a longer follow-up. They also plan to evaluate the utility of other biomarkers, such as brain natriuretic peptide.

No funding for the study was reported. Ardehali and Mouttet reported having no relevant financial relationships.