The Troponin Complex: Discriminating the Signal from the Noise

Area of Science:

• Cardiology
• Emergency Medicine
• Biomarker Assays

Background:

• Acute coronary syndrome (ACS) diagnosis relies on troponin assays for risk stratification.
• High-sensitivity troponin assays are increasing diagnoses of type 2 myocardial infarctions and myocardial injury.
• This leads to a growing population of patients with non-chest pain symptoms admitted for elevated troponin.

Purpose of the Study:

• To highlight the diagnostic and therapeutic challenges posed by the increasing prevalence of type 2 myocardial infarctions and myocardial injury.
• To emphasize the need for evidence-based treatment strategies for this heterogeneous patient group.
• To call for further research into the efficacy of established therapies in patients with type 2 myocardial infarction.

Main Methods:

• Review of current diagnostic practices for acute coronary syndrome using troponin assays.
• Analysis of the projected increase in type 2 myocardial infarction and myocardial injury diagnoses with high-sensitivity assays.
• Discussion of the heterogeneity and high adverse outcomes in this patient population.

Main Results:

• High-sensitivity troponin assays are expected to double admissions for type 2 myocardial infarctions and myocardial injury.
• Patients with type 2 myocardial infarction and myocardial injury exhibit high rates of readmission and death.
• Current guideline-directed treatments for ACS or type 1 myocardial infarction are not established for this cohort.

Conclusions:

• The optimal management strategy for patients with type 2 myocardial infarction and myocardial injury is currently undefined.
• Clinicians face uncertainty regarding appropriate hospital discharge therapies for these patients.
• Further clinical studies are essential to determine the value of specific treatments in improving outcomes for this population.