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Diagnosing myocardial infarction in the era of high-sensitivity troponin: the High-STEACS trial

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Original languageEnglish
JournalCardiovascular Research
Early online date7 Nov 2019
DOIs
Publication statusE-pub ahead of print - 7 Nov 2019

Abstract

High-sensitivity cardiac troponin is central to the diagnosis of myocardial infarction when measured in patients with signs or symptoms consistent with myocardial ischaemia. In this context, the Universal Definition of Myocardial Infarction (UDMI) mandates a rise and/or fall in troponin concentrations with at least one measure above the 99th centile of a healthy reference population.1 Increasing precision of cardiac troponin assays has allowed quantification of ever lower concentrations in the bloodstream, with detectable circulating levels present in over half of the healthy population.2 Where previous diagnostic thresholds were limited by assay precision, the 99th centile defines myocardial infarction by non-conformity with the healthy state at a population level. However, this approach is subject to inconsistencies according to the gender balance, ethnicity, and stringency of screening for disease within reference populations.3 Such controversies may have limited implementation of high-sensitivity assays and the full recommendations of the UDMI.4

While lowering the diagnostic threshold for myocardial infarction has previously been shown to improve patient outcomes,5 many clinicians fear that increasingly sensitive assays may compromise specificity, as low levels of cardiac troponin may be released in the absence of acute plaque rupture and coronary thrombosis, the hallmarks of a type 1 myocardial infarction.6 Until recently there have been no randomized trials of the UDMI or the introduction of high-sensitivity troponin assays, with guidance based solely on expert consensus and observational data.

The High-STEACS trial

ID: 118832545