The following are key points to remember from this article on high-sensitivity cardiac troponin (hs-cTn) and the Universal Definition of Myocardial Infarction (MI):

1. The introduction of more sensitive cTn assays has led to increased recognition of myocardial injury in acute illnesses other than acute coronary syndrome.
2. The Universal Definition of Myocardial Infarction recommends hs-cTn testing and classification of patients with myocardial injury based on pathogenesis, but the clinical implications of implementing this guideline are not well characterized or understood.
3. The investigators in a stepped-wedge cluster randomized, controlled trial, implemented a hs-cTn assay and the recommendations of the Universal Definition in 48,282 consecutive patients with suspected acute coronary syndrome.
4. In a prespecified secondary analysis, the authors compared the primary outcome of MI or cardiovascular death and secondary outcome of noncardiovascular death at 1 year across diagnostic categories.
5. This study suggests that implementation of hs-cTn assays and the recommendations of the Universal Definition of Myocardial Infarction identified patients at high risk of cardiovascular and noncardiovascular events, but was not associated with consistent increases in treatment or improved outcomes.
6. Trials of secondary prevention are indicated to determine whether this risk is modifiable in patients without type 1 MI.
7. Based on these data, clinicians should consider investigations to define coronary or structural heart disease in patients with type 2 MI and myocardial injury.
8. Furthermore, the risk of future cardiovascular events should be evaluated on an individual patient basis using all available clinical information.
9. Randomized, controlled trials of secondary prevention therapy are urgently needed, but until such data are available to inform clinical guidelines, clinicians should carefully assess cardiovascular risk on an individual patient basis to guide investigation and secondary prevention.
10. Overall, this study suggests that as hsTn and the latest iteration of the Universal Definition of Myocardial Infarction are integrated into clinical practice, there will be an increase in the number and the proportion of patients with elevated values of cTn who have a final diagnosis of type 2 MI, acute myocardial injury, or chronic myocardial injury. It is important for clinicans to note that these diagnoses are prognostically important and warrant clinical attention.

Clinical Topics: Acute Coronary Syndromes, Prevention, ACS and Cardiac Biomarkers

Keywords: Acute Coronary Syndrome, Acute Disease, Biomarkers, Diabetes Mellitus, Type 2, Myocardial Infarction, Myocardial Reperfusion Injury, Risk Factors, Primary Prevention, Secondary Prevention, Troponin

< Back to Listings