“Troponinitis” or “Troponinemia”: Terms that Trivialize Troponin Elevation Without a Specified Diagnosis

Troponin elevation is a common finding in acute patients admitted by an emergency service, even in the absence of an acute coronary event. There are patients in whom we simply cannot identify the origin of such troponin elevation. Initially, we relied on this marker as an exclusive marker of acute coronary syndrome. In consequence, many patients with troponin elevation sooner or later ended up in the cath lab, despite their inconclusive electrocardiograms and signs and symptoms of other diseases.

DETO2X-AMI: el O2 suplementario no aporta beneficios en pacientes con sospecha de infartoWe have encountered so many normal coronary arteries in this setting that somewhere along the line we popularized the terms “troponitis” and “troponinemia”.

 

This study aimed to investigate the association between troponin elevation and long-term clinical prognosis in acute patients admitted in the emergency room with suspected acute coronary syndrome, who were ultimately discharged without a specified diagnosis.


Read also: The Physiopathology Behind Valve Degeneration in TAVR.


This study analyzed retrospectively the 48,872-patient cohort from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) study. Patients were stratified according to their troponin levels into cohorts with troponin levels less than or equal to the cutoff (99th percentile), and all levels above the cutoff were separated by tertiles.

 

Positive troponin levels were identified in 20.1% of patients (n = 9800). As expected, the prevalence of cardiovascular risk factors as well as noncardiovascular comorbidities increased across higher tertiles.


Read also: Bundle Branch Block and Need for Permanent Pacemaker, a Major Challenge after TAVR.


In total, 15.4% of such patients with positive troponin levels who were discharged from their index hospitalization without a specified diagnosis had more events (cardiovascular death, acute myocardial infarction, readmission for heart failure, or stroke) over a mean follow-up of almost 5 years.

 

Conclusion

Troponin elevation is associated with cardiovascular and noncardiovascular comorbidities, and it predicts future events in acutely admitted patients, in whom no definite diagnosis could be established during their index hospitalization. The terms “troponinitis” and “troponinemia” trivialize the prognostic value of this marker and should be avoided, even if we cannot explain this phenomenon.

 

Original title: Cardiac Troponin Elevation in Patients Without a Specific Diagnosis.

Reference: Kai M. Eggers et al. J Am Coll Cardiol 2019;73:1-9.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

ACC-2025 Congress Second Day Key Studies

BHF PROTECT-TAVI (Kharbanda RK, Kennedy J, Dodd M, et al.)The largest randomized  trial carried out across 33 UK centers between 2020 and 2024, assessing...

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

CRABBIS Trial: Comparison of Different Provisional Stenting Sequences

Provisional stenting (PS) is the gold standard for percutaneous coronary intervention (PCI) in most patients with coronary bifurcation lesions (CBL). Moreover, recent studies such...

Andromeda Trial: Meta-Analysis of Drug Coated Balloon vs. DES in Small Vessel DeNovo Lesions

The use of coronary stents vs plain old balloon angioplasty (POBA), has allowed to reduce recoil and limiting flow dissection which were major limitation...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC-2025 Congress Second Day Key Studies

BHF PROTECT-TAVI (Kharbanda RK, Kennedy J, Dodd M, et al.)The largest randomized  trial carried out across 33 UK centers between 2020 and 2024, assessing...

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...