Unselected cardiac troponin testing and the diagnosis of myocardial infarction in the emergency department
Abstract Background This research examines the role of systematic cardiac troponin evaluation in identifying type 1 myocardial infarction among patients presenting to the emergency department with collected blood samples. Methods This was a prospective study of consecutive adult patients presenting...
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BMC
2025-03-01
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| Series: | BMC Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12873-025-01197-w |
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| author | Alfredo Bardají Oscar M. Peiro Maria Leyva-López Juan R. Delgado Mar Rocamora-Horach Montserrat Galofré Isabel Fort Anna Carrasquer Jose Luis Ferreiro |
| author_facet | Alfredo Bardají Oscar M. Peiro Maria Leyva-López Juan R. Delgado Mar Rocamora-Horach Montserrat Galofré Isabel Fort Anna Carrasquer Jose Luis Ferreiro |
| author_sort | Alfredo Bardají |
| collection | DOAJ |
| description | Abstract Background This research examines the role of systematic cardiac troponin evaluation in identifying type 1 myocardial infarction among patients presenting to the emergency department with collected blood samples. Methods This was a prospective study of consecutive adult patients presenting to the emergency department of a university hospital between October 22, 2020, and January 11, 2021. Cardiac troponin I levels were measured in all patients, including those with suspected acute coronary syndrome (clinical testing) and a control group undergoing routine blood tests (non-clinical testing). The primary outcomes were the prevalence of type 1 myocardial infarction and the positive predictive value of cardiac troponin I, which were assessed using established statistical methods. Results Elevated cardiac troponin levels were identified in 13.4% of the study population (382/2,853). This included 19.5% of patients with clinically guided tests and 10.1% of those with non-clinical testing. The overall prevalence of type 1 myocardial infarction was 2%, with a positive predictive value of 14.9% (95% CI: 13.6–16.2). Among clinically guided tests, type 1 myocardial infarction prevalence was 5.8%, yielding a positive predictive value of 29.5% (95% CI: 26.7–32.4). Cases from non-clinically guided tests were primarily attributed to type 2 myocardial infarction or non-ischemic myocardial injury. Conclusion Using a generalized approach to cardiac troponin testing in emergency department patients significantly lowers the diagnostic accuracy for type 1 myocardial infarction, reducing the positive predictive value and frequently indicating non-ischemic myocardial injury. |
| format | Article |
| id | doaj-art-eb29bd5b5d964f6db0b034c9fb9cfd89 |
| institution | DOAJ |
| issn | 1471-227X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj-art-eb29bd5b5d964f6db0b034c9fb9cfd892025-08-20T02:59:23ZengBMCBMC Emergency Medicine1471-227X2025-03-012511810.1186/s12873-025-01197-wUnselected cardiac troponin testing and the diagnosis of myocardial infarction in the emergency departmentAlfredo Bardají0Oscar M. Peiro1Maria Leyva-López2Juan R. Delgado3Mar Rocamora-Horach4Montserrat Galofré5Isabel Fort6Anna Carrasquer7Jose Luis Ferreiro8Department of Cardiology, Joan XXIII University HospitalDepartment of Cardiology, Joan XXIII University HospitalRovira i Virgili UniversityDepartment of Cardiology, Joan XXIII University HospitalDepartment of Cardiology, Joan XXIII University HospitalPere Virgili Health Research Institute (IISPV)Pere Virgili Health Research Institute (IISPV)Department of Cardiology, Joan XXIII University HospitalDepartment of Cardiology, Joan XXIII University HospitalAbstract Background This research examines the role of systematic cardiac troponin evaluation in identifying type 1 myocardial infarction among patients presenting to the emergency department with collected blood samples. Methods This was a prospective study of consecutive adult patients presenting to the emergency department of a university hospital between October 22, 2020, and January 11, 2021. Cardiac troponin I levels were measured in all patients, including those with suspected acute coronary syndrome (clinical testing) and a control group undergoing routine blood tests (non-clinical testing). The primary outcomes were the prevalence of type 1 myocardial infarction and the positive predictive value of cardiac troponin I, which were assessed using established statistical methods. Results Elevated cardiac troponin levels were identified in 13.4% of the study population (382/2,853). This included 19.5% of patients with clinically guided tests and 10.1% of those with non-clinical testing. The overall prevalence of type 1 myocardial infarction was 2%, with a positive predictive value of 14.9% (95% CI: 13.6–16.2). Among clinically guided tests, type 1 myocardial infarction prevalence was 5.8%, yielding a positive predictive value of 29.5% (95% CI: 26.7–32.4). Cases from non-clinically guided tests were primarily attributed to type 2 myocardial infarction or non-ischemic myocardial injury. Conclusion Using a generalized approach to cardiac troponin testing in emergency department patients significantly lowers the diagnostic accuracy for type 1 myocardial infarction, reducing the positive predictive value and frequently indicating non-ischemic myocardial injury.https://doi.org/10.1186/s12873-025-01197-wCardiac troponinMyocardial infarctionEmergency department |
| spellingShingle | Alfredo Bardají Oscar M. Peiro Maria Leyva-López Juan R. Delgado Mar Rocamora-Horach Montserrat Galofré Isabel Fort Anna Carrasquer Jose Luis Ferreiro Unselected cardiac troponin testing and the diagnosis of myocardial infarction in the emergency department BMC Emergency Medicine Cardiac troponin Myocardial infarction Emergency department |
| title | Unselected cardiac troponin testing and the diagnosis of myocardial infarction in the emergency department |
| title_full | Unselected cardiac troponin testing and the diagnosis of myocardial infarction in the emergency department |
| title_fullStr | Unselected cardiac troponin testing and the diagnosis of myocardial infarction in the emergency department |
| title_full_unstemmed | Unselected cardiac troponin testing and the diagnosis of myocardial infarction in the emergency department |
| title_short | Unselected cardiac troponin testing and the diagnosis of myocardial infarction in the emergency department |
| title_sort | unselected cardiac troponin testing and the diagnosis of myocardial infarction in the emergency department |
| topic | Cardiac troponin Myocardial infarction Emergency department |
| url | https://doi.org/10.1186/s12873-025-01197-w |
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