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Scott W Sharkey, Commentary, Clinical Chemistry, Volume 58, Issue 1, 1 January 2012, Pages 43–44, https://doi.org/10.1373/clinchem.2011.176289
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Troponin: Perhaps no other laboratory test has the authority to alter a patient's clinical course and cost of care so broadly. As the 2 case studies illustrate, an increased troponin concentration usually leads to concern for acute coronary syndrome and to evaluation with either stress testing or coronary artery imaging (or both), which in turn can lead to coronary artery revascularization (as with case 2). Indeed, it is broadly accepted that patients with an acute coronary syndrome and a troponin increase have a better outcome with an approach that includes medical management and coronary artery revascularization. Troponin assays are now exquisitely sensitive, and the assessment of the patient with an increased troponin value has become complicated. As the authors emphasize, “clinical judgment is essential.” A troponin increase should not automatically lead to either a hospital admission or a coronary angiogram.
The new troponin assays have exposed the vulnerability of the myocardial cell to stress (acute or chronic). Even running a marathon can lead to appreciable troponin release in an otherwise healthy heart (1). As the authors note, the list of conditions that cause troponin increases (dynamic or static) is substantial and ever increasing. This is an area of opportunity for research.
