ArticleCirculation2021
Cardiac Troponin Thresholds and Kinetics to Differentiate Myocardial Injury and Myocardial Infarction.
Article in Circulation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 52 papers, 2 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
Using Higher Cut-off Values to Diagnose Acute Myocardial Infarction in Patients With Elevated Hs-cTnT Concentrations
Characterization of Acute Myocardial Damage With Spectral Computed Tomography. CADAMI-SPECTRAL.
Who cites it
52 citing papers in PubMed, 2 syntheses or guidelines pooled it, 89 citations in OpenAlex.
- Utility of biomarkers in patients with a type 2 myocardial infarction: a systematic review.Open heart · 2026Pooled it
- 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
- Biomarker Concentrations and Their Temporal Changes in Patients With Myocardial Infarction and Nonobstructive Compared With Obstructive Coronary Arteries: Results From the PLATO Trial.Journal of the American Heart Association · 2023Trial
- Trial
- 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
- Validation of the myocardial-ischaemic-injury-index machine learning algorithm to guide the diagnosis of myocardial infarction in a heterogenous population: a prespecified exploratory analysis.The Lancet. Digital health · 2022Trial
- Type 1 and type 2 NSTEMI in atrial fibrillation: insights from the HERA-FIB registry.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Observational
- Contemporary Challenges and Strategies for Diagnosing and Managing in Type 2 Myocardial Infarction: A Narrative Review.Journal of personalized medicine · 2026Review
- Clinical Gray Zones of Cardiac Troponin Interpretation in the Emergency Department: When Increased Concentrations Do Not Equal Acute Coronary Syndrome.Journal of clinical medicine · 2026Review
- Integrative transcriptomic analysis identifies an oxidative stress-associated diagnostic signature for myocardial infarction.Journal of thrombosis and thrombolysis · 2026Article
- An easy-to-use model for screening type 2 myocardial infarction in geriatric patients with acute coronary syndrome: a retrospective cohort study.Frontiers in medicine · 2026Article
- Human Multi-Organ-on-a-Chip Platforms for Next-Generation Drug Delivery Strategies.Theranostics · 2026Review
- Recent advances in biomarkers for cardiac fibrosis.Frontiers in cardiovascular medicine · 2026Review
- Article
- Elevated Cardiac Troponin in Non-Cardiac Conditions Unrelated to Acute Myocardial Infarction.International journal of molecular sciences · 2025Review
- Predictive value of plaque features quantified by coronary CT angiography for periprocedural myocardial infarction in Non-ST-Segment elevation acute coronary syndrome.The international journal of cardiovascular imaging · 2025Observational
- Elevated Troponin, D-Dimers and D-Dimers/Fibrinogen Ratio Increase Mortality Risk in Remdesivir-Treated COVID-19 Patients.Journal of personalized medicine · 2025Article
- Cardiac troponin at the point of care in acute and chronic coronary syndromes.Diabetes, obesity & metabolism · 2025Review
- The Pathophysiology of Cardiac Troponin Release and the Various Circulating Cardiac Troponin Forms-Potential Clinical Implications.Journal of clinical medicine · 2025Review
- Using higher cut-off values to diagnose acute myocardial infarction in patients with elevated hs-cTnT.Journal of biomedical research · 2025Article
Corrections and comments
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Authors and funding
14 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundAlthough the 99th percentile is the recommended diagnostic threshold for myocardial infarction, some guidelines also advocate the use of higher troponin thresholds to rule in myocardial infarction at presentation. It is unclear whether the magnitude or change in troponin concentration can differentiate causes of myocardial injury and infarction in practice.
methodsIn a secondary analysis of a multicenter randomized controlled trial, we identified 46 092 consecutive patients presenting with suspected acute coronary syndrome without ST-segment-elevation myocardial infarction. High-sensitivity cardiac troponin I concentrations at presentation and on serial testing were compared between patients with myocardial injury and infarction. The positive predictive value and specificity were determined at the sex-specific 99th percentile upper reference limit and rule-in thresholds of 64 ng/L and 5-fold of the upper reference limit for a diagnosis of type 1 myocardial infarction.
resultsTroponin was above the 99th percentile in 8188 patients (18%). The diagnosis was type 1 or type 2 myocardial infarction in 50% and 14% and acute or chronic myocardial injury in 20% and 16%, respectively. Troponin concentrations were similar at presentation in type 1 (median [25th-75th percentile] 91 [30-493] ng/L) and type 2 (50 [22-147] ng/L) myocardial infarction and in acute (50 [26-134] ng/L) and chronic (51 [31-130] ng/L) myocardial injury. The 99th percentile and rule-in thresholds of 64 ng/L and 5-fold upper reference limit gave a positive predictive value of 57% (95% CI, 56%-58%), 59% (58%-61%), and 62% (60%-64%) and a specificity of 96% (96%-96%), 96% (96%-96%), and 98% (97%-98%), respectively. The absolute, relative, and rate of change in troponin concentration were highest in patients with type 1 myocardial infarction (
conclusionsAlthough we observed important differences in the kinetics, cardiac troponin concentrations at presentation are insufficient to distinguish type 1 myocardial infarction from other causes of myocardial injury or infarction in practice and should not guide management decisions in isolation. Registration: URL: https://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.