Arq. Bras. Cardiol. 2022; 118(6): 1016-1017
Troponin – Use it wisely. And as Another Instrument in the Clinic
Ricardo Wang
, Estevāo Lanna Figueiredo
This Short Editorial is referred by the Research article "Universal Definition of Myocardial Infarction 99th Percentile versus Diagnostic Cut-off Value of Troponin I for Acute Coronary Syndromes".
Acute myocardial infarction (AMI) and stable chronic coronary disease are the main causes of mortality in Brazil. In 2019, it was responsible for more than 170,000 deaths in Brazil. Given its severity, the Cardiology made a great effort to constantly improve the tools for the correct diagnosis to avoid the release of patients with Acute Coronary Syndrome (ACS) and its clinical and legal consequences. They are considered pillars for the diagnosis and a good anamnesis with the characterization of the type of pain, electrocardiographic changes, and biomarkers (mainly troponin).
Biomarkers play an important role in recognizing ACS, and diagnostic algorithms have adapted as they evolve. At first, they were nonspecific markers (e.g., lactic dehydrogenase, oxacetic transaminase, total creatine phosphokinase – CK). Then they evolved to a slightly more specific marker (creatine phosphokinase MB portion) with its difficult criteria: e.g., total CK/MB). Finally, we have an extremely specific marker of myocardial injuries, such as troponin. The evolution of biomarkers has allowed the simplification of chest pain protocols and the reduction of inappropriate discharge of patients with ACS. Due to troponin’s high sensitivity and specificity, in the fourth consensus on the universal definition of myocardial infarction, it was concluded that to establish the clinical diagnosis, an elevation above the 99th percentile of this biomarker was associated with clinical evidence of myocardial infarction ischemia. Given the low cutoff for troponin, there are doubts in this consensus regarding the clinical relevance.
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