Implementation of a high sensitivity cardiac troponin I assay and risk of myocardial infarction or death at five years: observational analysis of a stepped wedge, cluster randomised controlled trial

SPS commentary:

According to an editorial, cardiac troponins have replaced other blood biomarkers for diagnosis of myocardial injury and are widely used to risk stratify patients towards safe early discharge or further investigation of coronary anatomy when clinical and electrocardiographic features are suggestive of ACS. It notes high sensitivity assays can detect lower concentrations of cardiac troponin than older assays, improving test sensitivity and enabling earlier detection of myocardial injury. It adds however that it remains unknown whether use in emergency departments improves long-term clinical outcomes for patients with suspected ACS. It suggests that this trial provides novel information that could facilitate the design and conduct of future clinical trials as it raises more questions than answers. Confirmation of the findings are needed, along with a better understanding of the benefits reported for patients with non-ischaemic myocardial injury of cardiac origin. It also points out that although lower cut-offs for high sensitivity assays are increasingly used in accelerated protocols to rule out ACS, the long-term effects on clinical events remain unknown.