title: Stratified reporting of high sensitivity troponin I assay is associated with suboptimal management of patients with acute coronary syndrome and intermediate troponin elevation.
abstract: BACKGROUND
  Newer troponin assays provide high sensitivity and precision and are reported in a stratified manner by some laboratories. We sought to investigate the clinical impact of such reporting in the treatment of patients with suspected acute coronary syndrome (ACS).
  
  
  METHODS
  We identified patients presenting with suspected ACS over a one-year period. Patients were stratified based on their peak troponin I values within 24 hours of admission into the following categories as reported by our laboratory: troponin value ≤0.03 ng/ml, which is reported as normal (negative troponin group), troponin value 0.04-0.29 ng/ml, which is reported as suggestive of myocardial damage (intermediate troponin group), and troponin value ≥0.3 ng/ml which is reported as indicative of myocardial necrosis (high troponin group).
  
  
  RESULTS
  Plasma troponin concentrations were ≤0.03 ng/ml in 77 patients (68.7%), 0.04-0.29 ng/ml in 18 patients (16.1%), and ≥0.30 ng/ml in 17 patients (15.2%). Patients in the intermediate troponin group had thrombolysis in myocardial infarction (TIMI) risk scores that were similar to that of the high troponin group. Despite this, patients in the intermediate troponin group were almost 50% less likely to receive coronary angiography, anticoagulation, and clopidogrel when compared to the high troponin group.
  
  
  CONCLUSIONS
  Patients in the intermediate troponin group that meet the guideline definition of acute myocardial infarction are less likely to receive optimal medical and invasive therapy as compared to the high troponin group even though TIMI risk scores were similar in the two groups.
authors.affiliation: Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Jiwon
authors.initials: J
authors.lastname: Kim
authors.forename: Sainath
authors.initials: S
authors.lastname: Gaddam
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
authors.forename: Vikram
authors.initials: V
authors.lastname: Behera
authors.forename: Satish
authors.initials: S
authors.lastname: Sharma
authors.forename: Gaurav
authors.initials: G
authors.lastname: Choudhary
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis*; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D000077144:Clopidogrel; D015331:Cohort Studies; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis; D012189:Retrospective Studies; D012306:Risk; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D019210:Troponin I / Q000097:blood*; D028761:Withholding Treatment / Q000706:statistics & numerical data*
chemical_list: D000925:Anticoagulants; D019210:Troponin I; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: acute coronary syndrome; biological markers; myocardial infarction; sensitive troponin assay; troponin
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