Mitigation at che clinical significance of spurious elevations of cardiac troponin I in settings of coronary ischemia using serial testing of multiple cardiac markers

The ability to differentiate between true positives, false positives, and s poradically elevated cardiac troponin levels has grown in importance as car diac troponins assume an increasingly dominant role in the diagnosis of cor onary syndromes. In a population sample of 1,000 patients who presented con secutively to a large urban hospital emergency room, 50 of 112 patients who had elevated troponin levels (>0.6 ng/ml) during evaluation for myocardial injury were subsequently found to have had an isolated, spurious elevation of cardiac troponin, and not a diagnosed myocardial infarction, Logistic r egression analysis shows that by hierarchically analyzing electrocardiograp hic changes with concurrent creating kinase-MB and myoglobin levels at the time of the troponin elevation, one may predict with 91% accuracy whether t he troponin elevation is actually indicative of a myocardial infarction in a patient. Spurious troponin elevations may be a common occurrence, and if not detected, may result in on increased number of falsely diagnosed myocar dial infarctions. (C) 2001 by Excerpta Medica, Inc.