A single raised high-sensitivity troponin has many causes: acute MI, myocarditis, pulmonary embolism, sepsis, renal impairment, heart failure, and assay interference including macrotroponin and heterophile antibodies.
In acute chest pain, the change over one to three hours decides more than the absolute value. A stable, mildly raised result with no rise or fall points away from acute infarction. In a well outpatient with an isolated raised troponin I, a paired troponin T or a laboratory interference check can prevent unnecessary angiography.
- Repeat troponin at the interval your assay protocol specifies and judge the change, not one value.
- A flat, mildly raised troponin in chronic kidney disease or heart failure is usually chronic injury.
- If troponin I and T disagree by more than threefold, suspect interference, especially when troponin I is the raised one, and ask the laboratory.
- Record the assay used; values are not interchangeable between manufacturers.
Why it matters
Troponin is being measured in more well people, so more raised results will not mean heart attack.
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