18 Mar Do Elevated Troponins Always Indicate a Heart Attack?
MedicalResearch.com Interview with:
Prof. Nick Curzen BM(Hons) PhD FRCP
Professor of Interventional Cardiology/Consultant Cardiologist
University Hospital Southampton
MedicalResearch.com: What is the background for this study?
Response: The commonest blood test now used to assess whether a patient has had a heart attack or not is called high sensitivity troponin (hs trop). The test is supplied with an Upper Limit of Normal, which is based upon results from relatively healthy people. When doctors take the hs trop, they then use this ULN to decide if the patient had has a heart attack.
This study set out to see what the hs trop level is in a large number of patients attending the hospital for any reason, either inpatient or outpatient, in most of whom there was no clinical suspicion of heart attack at all. We therefore took hs trop measurements on 20,000 consecutive patients attending our hospital and having a blood sample for any reason.
MedicalResearch.com: What are the main findings?
Response: We found that overall 1 in 20 of these patients had a hs trop result above the ULN… in other words, in what is considered a range that could mean “heart attack”. The frequency with which patients had an abnormal hs trop varied according to age, gender and the reason they were having the blood test: for example, 39% of patients in critical care areas had a hs trop above the ULN.
MedicalResearch.com: What should readers take away from your report?
Response: The results are important because they highlight to doctors that they need to be very careful that they only use the hs trop test when the patient presents in a way that is classical for a heart attack, and that they interpret an abnormal result accordingly, because if patients receive treatments for a heart attack when they are not having one, this could be harmful.
The study results have important implications for the importance of educating staff in many areas of our hospitals in order to use this test appropriately. It may well be that the ULN needs to be different for different patient groups.
True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l729 (Published 13 March 2019)Cite this as: BMJ 2019;364:l729
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