What should be considered when using troponin levels in the diagnosis of unstable angina?

Updated: Oct 01, 2020
  • Author: Walter Tan, MD, MS; Chief Editor: Eric H Yang, MD  more...
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Answer

Because measurement of troponin is a very sensitive assay that detects myocardial injury or necrosis in the absence of CAD (eg, in critically ill or septic patients), newer mechanistic criteria have been put forth for a universal definition of MI by a joint task force of the European Society of Cardiology (ESC), the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), and the World Heart Federation (WHF). [31]

Fundamentally, this universal definition tries to identify patients in whom there may be an ACS wherein investigation or intervention might improve outcome (type I, or “spontaneous MI”). [31] Such an individual is distinguished from the patient in an intensive care unit (ICU) who has a type 2 MI or troponin elevation that is related to myocardial necrosis due to a supply-demand mismatch (eg, anemia, tachycardia, respiratory failure, or hypotension due to sepsis).

Although elevated troponins portend a graver prognosis for all of these cohorts, the latter patients are unlikely to benefit from an ischemia workup—and may indeed be harmed by an invasive strategy. [31]

There are also data suggesting that troponin T may be falsely elevated with major injury to skeletal muscles. Furthermore, qualitative bedside troponin assay results may be difficult to interpret in patients with renal insufficiency.


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