What We Talk About When We Talk About Troponin: A Descriptive Study of Troponin Terms

Clinical question: What terms are clinicians using to describe elevation in troponin levels in hospital discharge summaries?

What was already known: The 4th universal definition of MI was released in 2018, but uptake of its terminology has been slow. Imprecise use of descriptive language may create confusion about etiology of an elevated troponin level and may contribute to uncertainty regarding appropriate management.  

Methods: 257 patients who were admitted to the medical service in three RI hospitals in 2018 with two or more troponin measurements including at least one elevated value, as well as a rise and fall pattern.

Results/implications: 19 unique troponin terms were identified. Three implied normal troponin level, seven described an abnormal elevation without referencing specifically myocardial injury, and the rest referenced ischemia or infarction. Over one third of records had no troponin terms in the discharge summary.

Bottom line: In patients admitted with more than one elevated troponin value, clinicians used a wide variety of terms to describe elevations in discharge summaries deviating from the nomenclature of major cardiovascular societies’ guidelines. More precise language may facilitate appropriate evaluation and management of higher risk patients after discharge.