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Revealing the hidden threat behind detectable cardiac troponin levels in the emergency department
  1. Maribel Gonzalez-del-Hoyo1,2,
  2. Alfredo Bardaji3,4,5
  1. 1Cardiology, University Hospital Zurich, Zurich, Switzerland
  2. 2University of Zurich, Zurich, Switzerland
  3. 3Cardiology, Hospital Universitario Joan XXIII, Tarragona, Spain
  4. 4Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
  5. 5Department of Medicine and Surgery, Rovira i Virgili University, Reus, Spain
  1. Correspondence to Dr Maribel Gonzalez-del-Hoyo, Cardiology, University Hospital Zurich, Zurich, Switzerland; migonzalezhoyo{at}

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Cardiac troponin (cTn) plays a key role in diagnosing acute coronary syndrome (ACS) in the emergency department (ED).1 However, with the introduction of high-sensitivity (hs) assays for cTn and the need for biomarkers for cardiovascular risk stratification, their use has expanded beyond the diagnosis of ACS. A meta-analysis of 28 studies involving 154 052 participants showed that detectable high-sensitivity cardiac troponin (hs-cTn) levels below the 99th percentile were found in 60–80% of the general population and were associated with subsequent major adverse cardiovascular events (MACE).2 In the ED setting, the widespread use of cTn in patients with chest pain has uncovered large cohorts with detectable or elevated cTn levels, even though ultimately only 10–20% receive a final ACS diagnosis.1 The prognosis is far from negligible, with higher mortality rates linked to mildly elevated troponin levels, as well as an increased risk of MACE and death associated even with cTn concentrations below the 99th percentile.3 Moreover, adding detectable hs-cTnT levels to a clinical prediction model improved the prediction of death or myocardial infarction (MI) in patients with chest pain in the ED.4 Despite studies linking ‘normal’ cTn levels to adverse outcomes, patients with non-specific chest pain and cTn below the 99th percentile may not be recognised as being at increased risk.

In this context, the study by Cyon et al5 examined the prognostic value of detectable hs-cTnT in ED patients with chest pain and hs-cTnT levels below the 99th percentile. Further, the investigators are to be commended for extending previous findings by comparing outcomes with age and sex-stratified annual death …

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  • X @migonzalezhoyo

  • Contributors Both authors have contributed. The guarantor is MG-d-H.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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