Application of High-Sensitivity Troponin in Suspected Myocardial Infarction

Johannes T Neumann1, Raphael Twerenbold1, Francisco Ojeda1

  • 1From the University Heart Center Hamburg (J.T.N., R.T., F.O., N.A.S., T.Z., D.W., S.B.), German Center for Cardiovascular Research (DZHK) Partner Site Hamburg-Kiel-Lübeck (J.T.N., N.A.S., T.Z., D.W., S.B.), and the Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf (T.R.), Hamburg, the Department of Cardiology, Heidelberg University Hospital (M.M.-H., H.A.K., E.G.), and DZHK Partner Site Heidelberg-Mannheim (M.M.-H., H.A.K., E.G.), Heidelberg, Cardiology I (T.G., T.M.) and Preventive Cardiology and Preventive Medicine (P.W.), Center for Cardiology, and the Center for Thrombosis and Hemostasis (P.W.), University Medical Center of Johannes Gutenberg University Mainz, and the Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz (K.J.L.), Mainz, DZHK Partner Site Rhine-Main and the Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim (C.L., C.H., T.K.), the Department of Cardiology, Justus Liebig University of Giessen and Marburg, Giessen (C.L., C.H.), the Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin Institute of Health, and DZHK Partner Site Berlin, Berlin (U.L.), and the Institute of Epidemiology, Helmholtz Zentrum, German Research Center for Environmental Health (B.T., A.P.), and DZHK Partner Site Munich Heart Alliance (A.P.), Munich - all in Germany; the Cardiovascular Research Institute Basel and the Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland (R.T., J.B., T.N., P.B., C.M.); the British Heart Foundation Centre for Cardiovascular Science (A.R.C., A.S.V.S., A.A., N.L.M.) and the Usher Institute of Population Health Sciences and Informatics (A.S.V.S., N.L.M.), University of Edinburgh, Edinburgh, the University of Manchester and Manchester University Foundation Trust, Manchester (N.M., R. Body), U.K. Clinical Research Collaboration for Public Health, Queens University of Belfast, Belfast (F.K.), and the Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee (H.T.-P.) - all in the United Kingdom; the Department of Internal and Emergency Medicine, Lund University, Skåne University Hospital, Lund (A.M., U.E.), the Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm (T. Jernberg), the Department of Public Health and Clinical Medicine, and Heart Center, Cardiology, Umeå University, Umeå (S. Söderberg), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (B.L.) - all in Sweden; the Department of Medicine, University of Otago Christchurch, and Emergency Department, Christchurch Hospital, Christchurch, New Zealand (J.W.P., R.W.T., M.T.); the Departments of Emergency Medicine (J.G., L.A.C.) and Cardiology (W.P.), Royal Brisbane and Women's Hospital, Herston, QLD, and the Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove (J.G., W.P., L.A.C.) - all in Australia; the National Institute for Health and Welfare, Helsinki, Finland (V.S., K.K.); the Department of Epidemiology and Prevention, Istituto di Ricovero e Cura a Carattere Scientifico Neuromed, Pozzilli (L.I.), the Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese (L.I., M.M.F., R. Borchini), and the Department of Cardiovascular, Dysmetabolic, and Aging-Associated Diseases, National Institutes of Health, Rome (S.G.) - all in Italy; the Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T. Jørgensen), the Research Center for Prevention and Health, Capital Region of Denmark, Glostrup (T. Jørgensen), and the Medical Faculty, Aalborg University, Aalborg (T. Jørgensen) - all in Denmark; the Catalan Department of Health, Barcelona (S. Sans); and the Division of Emergency Medicine (A.W.) and the Department of Pathology and Molecular Medicine (P.A.K.), McMaster University, Hamilton, ON, Canada.

Insights

High-sensitivity troponin levels help predict myocardial infarction risk in emergency departments. Lower concentrations and minimal changes indicate a low risk of heart attack and 30-day adverse events.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Biomarkers

Background:

  • High-sensitivity troponin (hs-cTn) measurements are crucial for diagnosing myocardial infarction (MI) in emergency departments.
  • Assessing hs-cTn concentrations aids in determining MI probability and predicting short-term patient outcomes.

Purpose of the Study:

  • To evaluate the diagnostic and prognostic utility of hs-cTn I and hs-cTn T concentrations.
  • To develop a risk-assessment tool for MI and 30-day adverse events using hs-cTn data.

Main Methods:

  • Analysis of 15 international cohorts involving 22,651 patients presenting with MI symptoms.
  • Assessment of hs-cTn concentrations at presentation and during serial sampling.
  • Development and validation of a risk-assessment tool integrating hs-cTn levels, dynamic changes, and sampling time.

Main Results:

  • Lower hs-cTn concentrations and smaller absolute changes during serial sampling were associated with reduced MI likelihood and cardiovascular event risk.
  • hs-cTn I < 6 ng/L with < 4 ng/L change at 45-120 min yielded 99.5% negative predictive value for MI.
  • This low-risk group had a 0.2% 30-day risk of MI or death, with 56.5% of patients classified as low risk.

Conclusions:

  • A novel risk-assessment tool integrating hs-cTn concentration, dynamic changes, and sampling time can estimate MI probability.
  • The tool aids in predicting 30-day outcomes, enabling better risk stratification for patients with suspected MI.
  • Findings were validated in an external data set, confirming the tool's generalizability.
Abstract

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