Lowering the diagnostic threshold for acute coronary syndrome from a troponin I value of 0.20 to 0.05 ng/mL results in better clinical outcomes, according to a JAMA study.

Researchers examined outcomes in two groups of 1000 patients with suspected ACS during two 6-month periods. (The study was undertaken while their institution started using a more sensitive troponin I assay.) In the first period, troponin results were measured, but only values above the standard diagnostic threshold for ACS — 0.20 ng/mL — were reported. In the second period, the reportable threshold was lowered to 0.05 ng/mL.

After 1 year of follow-up, second-period patients meeting the new 0.05 threshold were more likely than first-period (non-reportable) patients with similar troponin levels to be referred to a cardiologist, receive dual antiplatelet therapy, and undergo coronary angiography. In addition, the rate of death or recurrent myocardial infarction was lower among second-period patients (21% vs. 39%).

Source:JAMA