With the introduction of more sensitive markers of myocardial
necrosis, it was shown that the diagnosis of (acute)
myocardial infarction could be improved. However, many patients without
myocardial infarction have elevated
troponin levels (low sensitivity), resulting in additional diagnostic testing and longer admission times to find the cause of the
troponin rise. Elevated
troponin levels in these patients were found to have limited diagnostic but strong prognostic value. This led to studies assessing the value of high-sensitivity
troponin in patients with stable disease, e.g.
coronary artery disease, or even in patients without apparent (clinical) disease. These studies consistently showed a strong association with long-term (cardiac) mortality. What is the value for the general physician in daily practice? Although
troponin levels may help in finding (healthy?) patients at higher risk, it remains unclear whether interventions (medication, lifestyle) are more (cost-)effective in this high-risk subgroup. The role of
troponin levels as a prognostic marker in stable patients therefore remains to be determined.