The predictive value of high sensitivity-troponin velocity within the first 6h of presentation for cardiac outcomes regardless of acute coronary syndrome diagnosis

Comparison of High-Sensitive Cardiac Troponin-T Changes between Non-ST-Segment Elevation Myocardial Infarction and Non-Coronary Artery Patients

“…In addition to ∆ troponin changes, troponin velocity, as a marker of temporal kinetics of troponin elevation, might differ between myocardial necrosis secondary to plaque rupture (type-I ACS) and supply/demand imbalance or direct myocardial toxicity (the main mechanisms in non-ACS) (23,24). Troponin velocity might aid in the early risk stratification of patients presenting with unclear reasons for troponin elevation and could present a subset of patients who would potentially benefit from early intervention.…”

“…Troponin velocity might aid in the early risk stratification of patients presenting with unclear reasons for troponin elevation and could present a subset of patients who would potentially benefit from early intervention. In addition, Chuang et al (23) showed that troponin velocity ≥ 2.5 ng/L/h within the first 6 hours was strongly associated with the increased risk of 12-month cardiac-specific and cardiac-related mortality or recurrent MI in patients with or without a final diagnosis of ACS. The present study showed that hs-cTnT velocity within the first 12 hours was significantly higher in the NSTEMI group in comparison with the non-ACS group (18.85 ± 84.89 ng/L/h vs. 4.96 ± 14.58 ng/L/h; P < 0.001), similar to absolute and relative hs-cTnT changes.…”

Rational clinical evaluation of suspected acute coronary syndromes: The value of more information

“…Age‐ and gender‐specific pre‐test probabilities were calculated using a separate published dataset of 38 161 patients presenting to EDs (Table S1). Positive and negative LRs were extracted from two published meta‐analyses: high‐sensitivity troponin T (hs‐troponin) from the CADTH meta‐analysis and the remainder from a JAMA meta‐analysis .…”

High-sensitivity troponin in chronic kidney disease: Considerations in myocardial infarction and beyond

“…A critical difference between the diagnoses of myocardial injury and acute MI is the disparity in evidence to inform clinical management. While there is rich evidence to guide the management of type 1 MI, there is little evidence to guide the management of patients with myocardial injury (Alpert et al, 2014;Amsterdam et al, 2014;Chuang et al, 2016;Roffi et al, 2016;. It is unclear whether the poor prognosis in myocardial injury is solely due to the influence of competing non-cardiac comorbidities (therefore difficult to modify) or secondary to myocardial injury and if so, whether these risks are amendable to current therapies.…”