Paper of the Month

August 2019

Application of High-Sensitivity Troponin in Suspected Myocardial Infarction. N Engl J Med. DZHK authors: J.T. Neumann, N.A. Sörensen, M. Mueller‐Hennessen, T. Gori, C. Liebetrau, C. Hamm, H.A. Katus, T. Münzel, U. Landmesser, B. Thorand, A. Peters, T. Keller, P. Wild, E. Giannitsis, T. Zeller, D. Westermann, and S. Blankenberg

The accurate and fast diagnosis of acute myocardial infarction within the emergency department is a highly relevant topic worldwide. The diagnostic evaluation is based on the clinical assessment, the electrocardiogram and measurement of the cardiac biomarker troponin, as well as its dynamic change over time.
In the multinational COMPASS-MI project, PD Dr. Johannes Neumann, Prof. Dirk Westermann and Prof. Stefan Blankenberg from the University Heart and Vascular Center Hamburg developed a novel approach to use troponin concentrations on a more flexibel and individualized level. For the project data from 21,455 patients with suspected myocardial infarction from 15 cohort studies in 13 countries was analysed. All patients had measurements of high-sensitivity troponin directly on admission and again at 45-120 minutes or 121-210 minutes. Based on this large COMPASS-MI dataset, the authors incorporated high-sensitivity troponin concentration, its absolute change, and resampling times in an easy-to-use tool that can be easily adopted in the clinical setting to derive negative and positive predictive values for myocardial infarction - from low to high risk of myocardial infarction.

Lower high-sensitivity troponin concentrations at presentation and smaller absolute changes during serial sampling were associated with a lower likelihood of myocardial infarction and a lower short-term risk of cardiovascular events.
These results allow the flexible and individual adaptation of rapid, troponin-based algorithms in patients with suspected acute myocardial infarction. This concept represents a paradigm shift as it extends the current approach from fixed limits to a individual risk prediction. Therefore, the study findings will have impact on the diagnostic evaluation in emergency departments worldwide.