He added, “The results can be used to stimulate debate about the way troponin measurements are requested and interpreted in the future because it is certainly not quite right at the moment.”

The cardiac troponin I assay used at University Hospital Southampton is the Beckman Coulter Access AccuTnI+3 assay, but the findings are “almost certainly relevant to the application of all modern hs-cTn assays,” Dr. Curzen and his colleagues note in their article.

This study is “very important,” Dr. Jay Giri, director of peripheral intervention and assistant professor of cardiovascular medicine in the Perelman School of Medicine at the University of Pennsylvania, told Reuters Health by email.

“Specifically, there has been a several-decades long push to improve the sensitivity of cardiac biomarkers for the detection of heart attacks. This has been primarily driven by a fear of missing any developing heart attacks, especially in the emergency room. But the unintended consequence of this is that a growing number of hospitalized patients are seen to have ‘positive’ cardiac biomarkers in the absence of a heart attack,” Dr. Giri explained.

“This consequence is not trivial as these patients often undergo workups that involve consultations, imaging tests, and invasive procedures to adjudicate the meaning of the abnormal biomarker. This imposes a significant burden on hospital resources and also exposes the patient to procedures that may be unnecessary or harmful,” said Dr. Giri. “The current study demonstrates that, while we have been dealing with this issue for some time, the promulgation of hs-troponin is likely to put this problem on steroids since large proportions of patients are in the hospital with hs-troponin values that are ‘abnormal’ despite no active cardiac complaints.”

Dr. Giri also mentioned that proponents of hs-troponin have said health care providers need to be educated in how to interpret the test in the context of a patient’s overall clinical presentation. “This is a commonsense approach, but I would argue that this has always been the case even in the days when we used slightly less sensitive biomarkers for heart attacks,” said Dr. Giri.

“An experienced clinical assessment with a cardiac biomarker as supporting information has always been the best way to diagnose a developing heart attack. So I am skeptical that having an ultrasensitive biomarker incrementally adds much to this optimal care pattern when its available. And when experienced clinicians are not available for rapid assessment of patients, I am worried that the all-too-common algorithms which base decisions on biomarker results will more often lead to unnecessary workups,” Dr. Giri concluded.