High-sensitivity blood testing increases the detection rate of myocardial injury
Published Mar. 06, 2024
By Hopkins Medtech
High-sensitivity cardiac troponin assays can improve detection accuracy at very low concentrations, enhancing the diagnosis and risk stratification of patients suspected of acute coronary syndrome. Therefore, the universal definition of myocardial infarction recommends the use of high-sensitivity cardiac troponin assays. While an increasing number of countries and regions are adopting these methods, their accuracy remains a subject of debate.
Based on this, scientists at the University of Edinburgh conducted a series of experiments to assess whether implementing high-sensitivity cardiac troponin I testing could reduce the incidence of myocardial infarction or death in patients suspected of acute coronary syndrome five years later.
The research team indicated that, five years later, it could reduce the future risk of heart attacks in high-risk patients by 10%. Moreover, the greatest benefits were observed in patients with myocardial injury caused by other heart conditions, such as heart failure, valvular heart disease, and arrhythmias. Compared to patients undergoing older, less sensitive tests, those who underwent the new testing experienced a nearly 10% decrease in future hospitalization rates and mortality over the five-year period.
The study was conducted in the emergency departments of 10 hospitals in Scotland, and the research findings were published in the British Medical Journal. “The new test can better predict the long-term outcomes for these patients, whether they experience a heart attack or other types of cardiac injury. This has the potential to enhance the care for patients in this category.
In the cohort, over 10,000 patients were found to have elevated levels of cardiac troponin, indicating the presence of cardiac injury. Approximately one-fifth of these patients could only be detected through the new high-sensitivity test, which can identify more subtle warning signals. The prognosis improved most significantly for patients diagnosed with non-ischemic myocardial injury.
By identifying patients with cardiac injuries that may be overlooked and require treatment, researchers hope that more individuals can receive the specialized cardiac care they need to prevent more serious events in the future. Some concerns were raised that lower diagnostic thresholds might reduce the specificity of cardiac troponin for type I myocardial infarction, potentially leading to misdiagnosis and unnecessary tests or treatments. However, researchers found no evidence of unnecessary treatment for acute coronary syndrome or harm to patients with non-ischemic myocardial injury. On the contrary,those diagnosed with non-ischemic myocardial injury showed the greatest improvement in outcomes over five years.
This study demonstrates that implementing high-sensitivity cardiac troponin testing in patients suspected of acute coronary syndrome can reduce subsequent myocardial infarction or 5-year mortality for those reclassified through high-sensitivity assays. The most significant improvement in prognosis was observed in patients diagnosed with non-ischemic myocardial injury, suggesting that cardiac troponin detection may have benefits beyond identifying myocardial infarctions.
