Predicting ACS in Patients with Troponin T Elevations

Clinical context is more important than troponin level when interpreting a positive test.

Troponin is detectable at very low levels, but a troponin “leak” does not always mean that an acute coronary syndrome (ACS) is present. To determine predictors of ACS in the presence of an abnormal troponin level, investigators studied 635 patients who had positive (>0.1 ng/mL) troponin tests during a 9-month period at two Israeli hospitals.

Two experts reviewed charts and retrospectively assigned a diagnosis of ACS (according to European Society of Cardiology/American College of Cardiology guidelines) to 53% of patients and a nonthrombotic cause to 41% (these patients had a definitive diagnosis of a condition known to cause troponin elevation, such as sepsis or pulmonary embolism). The diagnosis was unknown in 6%. Mean troponin T levels wer…

Reviewing Author

J. Stephen Bohan, MD, MS, FACP, FACEP