Tenascin-C demonstrated robust discriminative performance (AUC 0.85) and was the sole independent predictor of critical coronary stenosis in multivariate analysis among patients with non-ST-elevation acute coronary syndrome, outperforming hs-TnT particularly in the borderline troponin range.
Key Findings
Results
Tenascin-C levels were considerably greater in patients with critical CAD and demonstrated robust overall discriminative performance with an AUC of 0.85.
204 patients with NSTEMI or unstable angina pectoris (UAP) who underwent invasive coronary angiography were included in this prospective single-center observational study.
Critical CAD was defined as coronary artery stenosis ≥70% based on blinded angiographic assessment.
Serum Tenascin-C levels were measured within 48 hours using ELISA.
The AUC of 0.85 indicates robust discriminative performance between obstructive and non-obstructive CAD.
Results
Tenascin-C was the sole independent predictor of critical coronary stenosis in multivariate logistic regression analysis.
Multivariate analysis was performed evaluating the relationship between Tenascin-C, critical stenosis, GRACE score, and SYNTAX score.
No other variable retained independent predictive value for critical stenosis in the multivariate model.
This finding suggests Tenascin-C provides unique discriminatory information beyond conventional clinical variables.
Results
Tenascin-C showed a modest correlation with the GRACE score and a substantial correlation with the SYNTAX score.
Correlation analyses were used to evaluate the relationship between Tenascin-C and both GRACE and SYNTAX scores.
The SYNTAX score reflects the complexity and extent of coronary artery disease.
The GRACE score is a validated risk score for adverse outcomes in ACS.
A substantial correlation with SYNTAX score suggests Tenascin-C may reflect anatomical disease burden.
Results
Tenascin-C maintained good diagnostic accuracy (AUC 0.87) specifically in patients with borderline high-sensitivity troponin T (hs-TnT) levels.
The borderline hs-TnT range was defined as 12–52 ng/L.
AUC of 0.87 in this subgroup indicates good diagnostic accuracy even when conventional troponin values are inconclusive.
This finding highlights Tenascin-C's potential utility in the clinically challenging borderline troponin scenario.
Results
Tenascin-C demonstrated greater discriminative ability than hs-TnT for identifying critical coronary stenosis in patients with NSTEMI or UAP.
ROC curve analyses were used to compare the discriminative performance of Tenascin-C versus hs-TnT.
The superiority of Tenascin-C over hs-TnT was particularly pronounced in the borderline troponin range (12–52 ng/L).
hs-TnT is a standard biomarker currently used in ACS diagnosis and risk stratification.
The authors suggest Tenascin-C may provide complementary information to current biomarkers to support more precise clinical decision-making.
What This Means
This research suggests that a protein called Tenascin-C, measured in the blood, can reliably distinguish between patients who have a serious blockage in their coronary arteries (obstructive coronary artery disease) and those who do not, among people presenting with a type of heart attack or unstable chest pain known as non-ST-elevation acute coronary syndrome (NSTEMI or unstable angina). In a study of 204 patients, Tenascin-C blood levels were significantly higher in those found to have critical artery narrowing (≥70% blockage) on coronary angiography, and it was the only marker that independently predicted significant blockage when multiple factors were analyzed together.
One particularly important finding is that Tenascin-C performed well even in patients whose standard cardiac troponin test results were in a gray zone — not clearly normal or clearly elevated. This is a common and difficult clinical situation where doctors are uncertain whether a patient has truly had a heart attack. In this borderline troponin group, Tenascin-C achieved an AUC (a measure of diagnostic accuracy where 1.0 is perfect) of 0.87, outperforming the standard troponin test. The protein also correlated strongly with the SYNTAX score, which reflects how complex and widespread the coronary artery disease is.
This research suggests that Tenascin-C could serve as a useful additional blood test to help doctors more accurately identify which patients with chest pain actually have dangerous coronary blockages requiring intervention, especially when the standard tests are inconclusive. If confirmed in larger studies, this could help guide more timely and appropriate treatment decisions in emergency cardiac care.
İşletme A, Deveci S, Polat R, Özkan B, Güler E, Hayıroğlu M, et al.. (2026). Tenascin-C differentiates obstructive from non-obstructive coronary artery disease in non-ST-elevation acute coronary syndrome.. International journal of cardiology. https://doi.org/10.1016/j.ijcard.2026.134751