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Interpreting Troponin Tests: Coming to a New Consensus

Interpreting Troponin Tests: Coming to a New Consensus

Since its introduction in the early 1990s, cardiac troponin testing has been predominantly used to diagnose or rule out myocardial infarction (MI) in patients with possible symptoms of MI. However, it has become clear that a positive troponin indicates that cardiac injury has occurred, but it is not specific for the etiology of the injury. “Experience with troponin testing has also showed that higher levels identify patients at greater risk for adverse events, regardless of the clinical setting (eg, MI, heart failure, or non-cardiac etiologies),” explains L. Kristin Newby, MD, MHS, FACC, FAHA. “However, more recent studies have raised questions about cardiac troponin cutoffs that should be used for diagnostic and prognostic interpretations and the particular importance of the clinical context in making those interpretations.” In the Journal of the American College of Cardiology, Dr. Newby and colleagues from seven professional societies, led by the American College of Cardiology, released a consensus statement to help clinicians determine when to order troponin testing and how to interpret results. The document provides a framework for clinicians to interpret results of troponin testing in a useful mechanism-based construct. Key Recommendations on Troponin Testing According to the consensus statement, physicians should adopt the definition of MI that was recently updated in order to fully understand the implications of elevated troponin levels. “The universal definition of MI, which was updated in 2012, is important because it provides a standard framework in which to apply troponin testing for a diagnosis of MI and emphasizes not only troponin levels, but also the importance of clinical symptoms of MI,” Dr. Newby says. In addition, the consensus statement...
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