Trial reportCirculation2020
High-Sensitivity Cardiac Troponin and the Universal Definition of Myocardial Infarction.
Trial report in Circulation, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01852123 (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome), which is not on this map. Cited by 98 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome: A Randomized Controlled Trial
Who cites it
98 citing papers in PubMed, 3 syntheses or guidelines pooled it, 199 citations in OpenAlex.
- 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee.Journal of the American College of Cardiology · 2022Guideline
- Pooled it
- EAPCI Position Statement on Invasive Management of Acute Coronary Syndromes during the COVID-19 pandemic.European heart journal · 2020Guideline
- Implementation of a high sensitivity cardiac troponin I assay and risk of myocardial infarction or death at five years: observational analysis of a stepped wedge, cluster randomised controlled trial.BMJ (Clinical research ed.) · 2023Trial
- Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial.European heart journal. Acute cardiovascular care · 2022Trial
- Assessment of Oxygen Supply-Demand Imbalance and Outcomes Among Patients With Type 2 Myocardial Infarction: A Secondary Analysis of the High-STEACS Cluster Randomized Clinical Trial.JAMA network open · 2022Trial
- Risk factors for type 1 and type 2 myocardial infarction.European heart journal · 2022Trial
- Trimetazidine offers myocardial protection in elderly coronary artery disease patients undergoing non-cardiac surgery: a randomized, double-blind, placebo-controlled trial.BMC cardiovascular disorders · 2021Trial
- Performance of the GRACE 2.0 score in patients with type 1 and type 2 myocardial infarction.European heart journal · 2021Trial
- PAR1 (Protease-Activated Receptor 1) Pepducin Therapy Targeting Myocardial Necrosis in Coronary Artery Disease and Acute Coronary Syndrome Patients Undergoing Cardiac Catheterization: A Randomized, Placebo-Controlled, Phase 2 Study.Arteriosclerosis, thrombosis, and vascular biology · 2020Trial
- Contemporary Challenges and Strategies for Diagnosing and Managing in Type 2 Myocardial Infarction: A Narrative Review.Journal of personalized medicine · 2026Review
- Revisiting the Universal Definition of Myocardial Infarction: A Case for Extraluminal Coronary Occlusion as a Distinct Entity.Annals of cardiac anaesthesia · 2026Article
- Review
- Non-ST-Elevation Myocardial Infarction: A Heterogeneous Syndrome with Evolving Management-A Narrative Review.Biomedicines · 2026Review
- In situ electrochemiluminescence microneedle device for real-time biomarker monitoring in vivo.Nature communications · 2026Article
- Senkyunolide I and Danshensu in combination ameliorate post-MI myocardial fibrosis by regulatingFrontiers in pharmacology · 2026Article
- Article
- Myocardial infarction redefined: mechanism matters more than type.Cardiology journal · 2026Article
- Cardiovascular and non-cardiovascular mortality at 5 years in patients with type 1 and type 2 myocardial infarction.European heart journal. Acute cardiovascular care · 2025Article
- The assessment and management of patients with type 2 myocardial infarction: an international Delphi study.European heart journal. Quality of care & clinical outcomes · 2025Article
38 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
23 authors at 11 institutions in 3 countries.
Funding
Abstract
backgroundThe introduction of more sensitive cardiac troponin assays has led to increased recognition of myocardial injury in acute illnesses other than acute coronary syndrome. The Universal Definition of Myocardial Infarction recommends high-sensitivity cardiac troponin testing and classification of patients with myocardial injury based on pathogenesis, but the clinical implications of implementing this guideline are not well understood.
methodsIn a stepped-wedge cluster randomized, controlled trial, we implemented a high-sensitivity cardiac troponin assay and the recommendations of the Universal Definition in 48 282 consecutive patients with suspected acute coronary syndrome. In a prespecified secondary analysis, we compared the primary outcome of myocardial infarction or cardiovascular death and secondary outcome of noncardiovascular death at 1 year across diagnostic categories.
resultsImplementation increased the diagnosis of type 1 myocardial infarction by 11% (510/4471), type 2 myocardial infarction by 22% (205/916), and acute and chronic myocardial injury by 36% (443/1233) and 43% (389/898), respectively. Compared with those without myocardial injury, the rate of the primary outcome was highest in those with type 1 myocardial infarction (cause-specific hazard ratio [HR] 5.64 [95% CI, 5.12-6.22]), but was similar across diagnostic categories, whereas noncardiovascular deaths were highest in those with acute myocardial injury (cause specific HR 2.65 [95% CI, 2.33-3.01]). Despite modest increases in antiplatelet therapy and coronary revascularization after implementation in patients with type 1 myocardial infarction, the primary outcome was unchanged (cause specific HR 1.00 [95% CI, 0.82-1.21]). Increased recognition of type 2 myocardial infarction and myocardial injury did not lead to changes in investigation, treatment or outcomes.
conclusionsImplementation of high-sensitivity cardiac troponin 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. Trials of secondary prevention are urgently required to determine whether this risk is modifiable in patients without type 1 myocardial infarction. CLINICAL
trial registrationhttps://www.clinicaltrials.gov. Unique identifier: NCT01852123.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.