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Cardiac troponin: the next tool for cardiovascular disease prevention in ambulatory patients?
  1. Brendan M Everett
  1. Divisions of Cardiovascular and Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215, USA
  1. Correspondence to Dr Brendan M Everett, Brigham and Women’s Hospital, 900 Commonwealth Ave, Boston, MA 02215, USA; beverett{at}partners.org

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Cardiac troponin plays an essential role in the diagnosis of myocardial infarction (MI). High-sensitivity assays for cardiac troponin, which are now in widespread clinical use, improve the accuracy of MI diagnosis, particularly for patients who present soon after the onset of symptoms. These high-sensitivity assays can detect cardiac troponin concentrations in stable, ambulatory patients. Circulating concentrations of high-sensitivity cardiac troponin (hs-cTn), even when they are well within the putative normal range, have been found to associate closely with the risk of major cardiovascular events in a wide array of cohorts. A number of these strong, consistent associations from a sampling of prospective cohort studies are outlined in table 1.1–7 These results, and others, raise the possibility that high-sensitivity assays for cardiac troponin could provide clinical utility for the prediction and prevention of cardiovascular events in stable, ambulatory patients.

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Table 1

Proportion of patients with a detectable cardiac troponin in a sampling of cohorts with and without established coronary heart disease, and the association of cardiac troponin with cardiovascular endpoints in those studies

What criteria should we use to determine whether hs-cTn has clinical utility in stable patients? Morrow and de Lemos outlined a number of benchmarks to use as a means of assessing the ability of a novel biomarker to improve clinical care.8 Those benchmarks, summarised here, are worth reviewing as we consider whether hs-cTn might have a role in managing ambulatory patients: (1) Can we measure cardiac troponin easily and reliably? (2) Is there a consistent, independent association between cardiac troponin and major cardiovascular events? (3) Does using cardiac troponin allow us to improve upon existing means of risk prediction or risk stratification? (4) Does using cardiac troponin allow us to identify a specific group of patients who would derive benefit from a specific …

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