{"id":9212,"date":"2020-01-28T15:48:44","date_gmt":"2020-01-28T20:48:44","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=9212"},"modified":"2020-02-04T09:31:14","modified_gmt":"2020-02-04T14:31:14","slug":"the-emerging-importance-of-high-sensitivity-cardiac-troponin-in-fourth-universal-definition-of-myocardial-infarction-and-its-prognostic-outcome","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=9212","title":{"rendered":"Trial Showed Implementation of High Sensitivity Cardiac Troponin Assays and Universal Definition of Myocardial Infarction Recommendations in Patients with Suspected Acute Coronary Syndrome Increased Diagnosis Rate Without a Change in Outcomes"},"content":{"rendered":"

A recent study by Dr. Chapman, published in Circulation<\/a><\/em>, showed that implementation of high sensitivity cardiac troponin (hs-cTn) and the fourth universal definition of myocardial infarction (MI) increased the identification of patients at risk for cardiovascular and non-cardiovascular events, but failed to improve the outcomes. This study warrants the importance of seeking new strategies to improve outcomes in patients with type 2 MI and myocardial injury.<\/p>\n

The fourth universal definition of MI recommends using hs-cTn and the 99th centile upper reference limit as the diagnostic threshold for MI. It also suggests the term “myocardial injury” as a sole increase in the hs-cTn value in the absence of other criteria for diagnosing myocardial infarction. The clinical implication of this modification, though, is yet to be fully discovered and recognized.<\/p>\n

In a stepped-wedge cluster-randomized, controlled trial, a total of 48,282 consecutive patients with a history suggesting acute coronary syndrome were recruited. Participants were reclassified according to the Fourth Universal Definition of Myocardial Infarction. Type 1 or 4b MI or cardiovascular death at 1-year was considered as the primary outcome of the study. The secondary outcomes included all-cause death, cardiovascular death, cardiac death, non-cardiovascular death, duration of stay, myocardial infarction (type 1 or type 4b), unplanned coronary revascularization, hospitalization for heart failure, ischemic stroke, major hemorrhage, and unplanned hospitalization.<\/p>\n

Using hs-cTn, the diagnosis of type 1 MI increased by 11% (510\/4471), type 2 MI by 22% (205\/916), acute myocardial injury by 36% (443\/1233), and chronic myocardial injury by 43% (389\/898).\u00a0 The primary outcome had the highest rate in those with type 1 MI when compared with those without myocardial injury (cause-specific HR 5.64 [95% CI, 5.12 – 6.22]). However, this outcome occurred with a qualitatively similar frequency among patients with type 2 MI (cause-specific HR 3.50 [95% CI, 2.94 – 4.15]), acute myocardial injury (cause-specific HR 4.38 [95% CI, 3.80 – 5.05]), and chronic myocardial injury (cause-specific HR 3.88 [95% CI, 3.31 – 4.55]). In contrast, non-cardiovascular deaths were highest in those with acute myocardial injury (cause-specific HR 2.65 [95% CI, 2.33 – 3.01]). No reduction was observed in the primary outcome of patients with type 1 MI (cause-specific HR 1.00 [95% CI, 0.82 – 1.21]) despite the increasing use of antiplatelet agents and coronary revascularization. Additionally, an increase in the recognition of type 2 MI and myocardial injury did not change their associated adverse outcomes.<\/p>\n

This study showed similar cardiovascular outcomes in patients with type 2 MI and myocardial injury as well as a higher rate of non-cardiovascular death in these two groups. While the application of hs-cTn showed clear prognostic values, its clinical use has made no change to improve the outcomes. These data showed the importance of clinical attention to an increased hs-cTn value and its prognostic value as well as a need for considering new secondary preventive measurements to improve its associated clinical outcomes. Given the results of this study, a need to pursue additional non-invasive workup in patients without a clear cause of acute myocardial injury to identify unknown structural heart disease is felt.<\/p>\n","protected":false},"excerpt":{"rendered":"

A recent study by Dr. Chapman, published in Circulation, showed that implementation of high sensitivity cardiac troponin (hs-cTn) and the fourth universal definition of myocardial infarction (MI) increased the identification of patients at risk for cardiovascular and non-cardiovascular events, but failed to improve the outcomes. This study warrants the importance of seeking new strategies to […]<\/p>\n","protected":false},"author":9987,"featured_media":9206,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[206,226,184,228,20],"tags":[47,185],"ppma_author":[240],"class_list":{"0":"post-9212","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-atherosclerotic-cardiovascular-disease","8":"category-biomarkers","9":"category-clinical-trials","10":"category-myocardial-infarction","11":"category-structural-heart-disease","12":"tag-featured","13":"tag-news","14":"author-cap-sahar"},"authors":[{"term_id":240,"user_id":0,"is_guest":1,"slug":"cap-sahar","display_name":"sahar","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/9212","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/9987"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=9212"}],"version-history":[{"count":11,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/9212\/revisions"}],"predecessor-version":[{"id":9234,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/9212\/revisions\/9234"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/9206"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=9212"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=9212"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=9212"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=9212"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}