Wednesday, November 21, 2012

All Elevated Troponins Are Not MI

Have you ever received sign-out on a patient, heparinized, awaiting cardiology consultation – and later, at your leisure, realized the troponin level just barely tips into positive territory and probably has nothing to do with acute coronary syndrome?

I know you have.


This is the cardiology "expert consensus" on interpretation of troponin elevations – 25 pages of clinical summary and 360 references worth of dissecting what an elevated troponin really means.  There's an hour-long lecture worth giving based on this publication.


The key portions include:
 - Figure 1, which is a nice conceptual overview in which elevated troponins are separated into their "ACS" and "non-ACS" categories.
 - Section 6, which discusses the possible role (if any) for troponins in non-ischemic conditions.
 - Appendix 4, the clinical conditions in which positive troponins are non-cardiac and confounding in origin.


Positive troponins need to be evaluated properly in their clinical context, and this is a lovely (if very, very long) reference document for describing it.


"ACCF 2012 Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations"
www.ncbi.nlm.nih.gov/pubmed/23154053

1 comment:

  1. That's helpfull, since with the advent of ultra-low specificity troponin the incidence of troponinitis increased by several order of magnitude...

    ReplyDelete

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