Journal club: key troponin papers

Bottom line:In 4,663 ED patients with chest discomfort, ESC 0/1-hour algorithm, High-STEACS 0/2-hour or 0/3-hour pathway, ESC was more sensitive and specific; High-STEACS ruled out more patients.

Bottom line:In 31,492 patients with suspected ACS and troponin below the 99th percentile, early rule-out below 5 ng/L at presentation, rule-out at 6 to 12 hours, shorter stay and more discharges, with no rise in cardiac events at 1 year.

Bottom line:In 22,651 ED patients with symptoms of MI, hs-troponin at presentation plus its change and timing, gave patient-level probabilities of MI and 30-day events.

Bottom line:In 22,457 patients with suspected ACS, hs-cTnI below 5 ng/L at presentation, identified half as low risk, with NPV 99.5% for MI or cardiac death at 30 days.

Bottom line:In adults with possible ACS in the ED, a single hs-cTnT below 5 ng/L with a non-ischemic ECG, ruled out MI with pooled sensitivity 98.7%, missing 0.5% of those called low risk.

Bottom line:In patients reclassified as having myocardial injury, hs-cTnI implementation, the contemporary assay period, MI or death at 5 years fell from 63.0% to 53.9%, mainly in non-ischemic injury.

Bottom line:In 550 U.S. hospitals, use of hs-cTn assays, less sensitive assays, modestly shorter stay and less angiography in low-risk patients, with no mortality difference.

Bottom line:In 250 patients with MI excluded, hs-cTnI between 5 ng/L and the 99th percentile, hs-cTnI below 5 ng/L, coronary disease on CT in 72% versus 43%.

Bottom line:In 48,282 patients with suspected ACS, hs-troponin with Universal Definition categories, the contemporary assay, more diagnoses of every kind, with little change in treatment or outcome.

Bottom line:In 48,282 patients with suspected ACS, hs-cTnI with sex-specific 99th percentile thresholds, a contemporary assay, reclassified 17% more patients but did not lower MI or cardiovascular death at 1 year.

Bottom line:In 2,544 ED patients with possible MI, introduction of hs-cTnT, the earlier assay, no rise in angiography; less stress testing and a faster discharge.

Bottom line:In patients with suspected ACS and troponin 0.05 to 0.19 ng/mL, a lower diagnostic threshold (0.05 ng/mL), the old threshold (0.20 ng/mL), death or recurrent MI at 1 year fell from 39% to 21%.

Bottom line:In 48,282 patients, women and men, sex-specific hs-cTnI thresholds, the contemporary assay, 5 times more women than men were newly identified, treated about half as often, with no outcome change.

Bottom line:In 2,734 patients with suspected MI, sex-specific hs-cTnT cutoffs, a uniform cutoff, reclassified only 3 patients, and the authors favored the uniform cutoff.

Bottom line:In 46,927 patients with and without eGFR below 60, hs-cTnI implementation, the contemporary assay, more diagnoses, but unchanged disparities in treatment and outcome.

Bottom line:In patients with suspected ACS and eGFR below 60, hs-cTnI rule-out and the 99th percentile, patients with normal kidney function, fewer ruled out, lower specificity, and twice the 1-year event risk when elevated.

Bottom line:In 857 ED patients with troponin elevation, type 2 MI with objective evidence of ischemia, myocardial injury and symptom-only type 2 MI, higher mortality only when objective evidence was present.

Bottom line:In 100 patients with provisional type 2 MI, systematic coronary and cardiac imaging, found coronary disease in two-thirds and LV dysfunction in one-third, mostly untreated.

Bottom line:In 48,872 acutely admitted patients without a specific diagnosis, troponin above the 99th percentile, troponin at or below the 99th percentile, higher long-term risk of death, MI, heart failure, or stroke, even without obvious disease.

Bottom line:In 3,853 ED patients with hs-cTnT above 14 ng/L, acute injury, type 1 MI, or type 2 MI, chronic myocardial injury, chronic injury carried about as much long-term mortality as acute injury.

Bottom line:In 2,122 patients with elevated troponin I, type 2 MI or myocardial injury, type 1 MI, higher 5-year death, mostly non-cardiovascular, with similar cardiovascular event rates.

Bottom line:In 164,054 people from the general population, adding hs-troponin, NT-proBNP, or hs-CRP to risk factors, risk factors alone, small gain for atherosclerotic disease, larger for heart failure and death.

Bottom line:In 9,289 patients with chronic heart failure, higher hs-cTnT, lower hs-cTnT, higher all-cause death (HR 1.48), cardiovascular death, and hospitalization, beyond NT-proBNP.

Bottom line:In 154,052 people without prior cardiovascular events, high troponin within the normal range, low troponin, higher risk of CVD (RR 1.43), strongest for fatal CVD.

Bottom line:In 3,346 patients with suspected MI, hs-cTnT gen 6, hs-cTnT gen 5, same accuracy, fewer patients above the limit, and new assay-specific cutoffs.

Bottom line:In 1,058 healthy people, removing macrotroponin-positive samples, the full sample, the Siemens hs-cTnI 99th percentile dropped from 117 to 22 ng/L in men.

Bottom line:In 1,102 ED patients with chest discomfort, a point-of-care hs-cTnI assay, central-laboratory hs-troponin, equal accuracy and a working 0/1-hour algorithm.

Bottom line:In 2,560 patients with suspected MI, machine-learning rule-out with one point-of-care hs-cTnI, ESC and ACC 0-hour pathways, ruled out more than twice as many patients with NPV 99.96%.

Bottom line:In 624 patients with suspected ACS, three different hs-troponin assays, agreed on benchmark category in only 37% of samples and on management in about 75% of patients.

Bottom line:In 1,412 patients with NSTEMI undergoing PCI, post-PCI troponin I rise above 40% and at least 5 times the limit, smaller rises, worse 1-year death and adverse events.

Bottom line:In 60 patients with ICI myocarditis, cTnT measured early, cTnI and CK, cTnT was the most sensitive and best predicted major events.

Bottom line:In 2,829 patients after CABG, perioperative MI by the 4th UDMI or ARC, the SCAI definition and biomarker-only criteria, the stricter definitions predicted death; biomarker release alone did not.

Bottom line:In patients on immune checkpoint inhibitors, myocarditis, ICI patients without myocarditis, 46% had major cardiac events, with higher risk at troponin T of 1.5 ng/mL or more.