Interpreting troponin elevations: do we need multiple diagnoses?

The expanded ability to detect myocardial injury using very sensitive and specific biomarker assays has been a major factor in the evolution of the definition of acute myocardial infarction (MI). This is clearly evident in the ‘Universal Definition of Myocardial Infarction’ recently developed by a joint task force of experts on behalf of the ESC, ACCF, AHA, and WHF (European Society of Cardiology, American College of Cardiology Foundation, American Heart Association, and World Heart Federation). In a clinical setting consistent with myocardial ischaemia, criteria are presented for defining acute MI that include a rise and/or fall in cardiac biomarkers together with symptoms of ischaemia, and/or appropriate ECG changes, and/or imaging evidence of a new regional wall motion abnormality or loss of myocardium. The task force developed a clinical classification of different types of MI that can be briefly summarized as: