Review Addresses Misclassification Risks in High-Sensitivity Troponin Testing

A narrative review argues that while high-sensitivity cardiac troponin assays reliably detect myocardial injury, correctly classifying that injury remains a major clinical challenge. The authors state that nonischemic injury is often mislabeled as secondary myocardial infarction, while chronic myocardial injury carrying a risk of future MI or cardiovascular death is frequently dismissed once infarction is ruled out. The review proposes interpretation grounded in assay biology, serial testing algorithms, the Fifth Universal Definition of MI, and recognition of non-ACS conditions causing expected troponin elevation, and offers bedside guidance for scenarios such as suspected secondary MI and troponin elevation without a dynamic pattern.

Most relevant for: Clinicians interpreting troponin results in patients with suspected acute coronary syndrome or with conditions such as chronic kidney disease, heart failure, sepsis, tachyarrhythmias, pulmonary embolism, or takotsubo syndrome where troponin elevation is expected.

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