High-Sensitivity Cardiac Troponin and the Universal Definition of Myocardial Infarction – DocWire News

Background:

The introduction of more sensitive cardiac troponin assays has led to increased recognition ofmyocardialinjury in acute illnesses other than acute coronary syndrome. The Universal Definition ofMyocardial Infarctionrecommends high-sensitivity cardiac troponin (hs-cTn) testing and classification of patients withmyocardialinjury based on aetiology, but the clinical implications of implementing this guideline are not well understood.

In a stepped-wedge cluster randomized controlled trial, we implemented a hs-cTn assay and the recommendations of the Universal Definition in 48,282 consecutive patients with suspected acute coronary syndrome. In a pre-specified secondary analysis, we compared the primary outcome ofmyocardial infarctionor cardiovascular death and secondary outcome of non-cardiovascular death at one year across diagnostic categories.

Implementation increased the diagnosis of type 1myocardial infarctionby 11% (510/4,471), type 2myocardial infarctionby 22% (205/916), and acute and chronicmyocardialinjury by 36% (443/1,233) and 43% (389/898), respectively. Compared to those withoutmyocardialinjury, the rate of the primary outcome was highest in those with type 1myocardial infarction(cause-specific hazard ratio [csHR] 5.64, 95% confidence interval [CI] 5.12 to 6.22), but was similar across diagnostic categories, whereas non-cardiovascular deaths were highest in those with acutemyocardialinjury (csHR 2.65, 95%CI 2.33 to 3.01). Despite modest increases in anti-platelet therapy and coronary revascularization after implementation in patients with type 1myocardial infarction, the primary outcome was unchanged (csHR 1.00, 95%CI 0.82 to 1.21). Increased recognition of type 2myocardial infarctionandmyocardialinjury did not lead to changes in investigation, treatment or outcomes.

Implementation of high-sensitivity cardiac troponin and the recommendations of the Universal Definition ofMyocardial Infarctionidentified patients at high-risk of cardiovascular and non-cardiovascular events, but was not associated with consistent increases in treatment or improved outcomes. Trials of secondary prevention are urgently required to determine whether this risk is modifiable in patients without type 1myocardial infarction.

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High-Sensitivity Cardiac Troponin and the Universal Definition of Myocardial Infarction - DocWire News