Objective To evaluate the impact of implementing a high sensitivity assay for cardiac troponin I on long term outcomes in patients with suspected acute coronary syndrome.
Design Secondary observational analysis of a stepped wedge, cluster randomised controlled trial.
Setting 10 secondary and tertiary care centres in Scotland, UK.
Participants 48 282 consecutive patients with suspected acute coronary syndrome. Myocardial injury was defined as any high sensitivity assay result for cardiac troponin I >99th centile of 16 ng/L in women and 34 ng/L in men.
Intervention Hospital sites were randomly allocated to either early (n=5 hospitals) or late (n=5 hospitals) implementation of a high sensitivity cardiac troponin I assay with sex specific diagnostic thresholds.
Main outcome measure The main outcome was myocardial infarction or death at five years.
Results 10 360 patients had cardiac troponin concentrations greater than the 99th centile, of whom 1771 (17.1%) were reclassified b
Denmark: In middle-aged, asymptomatic adults, subclinical, obstructive coronary atherosclerosis is linked with a more than 8-fold increased risk for myocardial infarction over three years than those.
An analysis of more than 9000 adults aged 40 and older without known cardiovascular disease is shedding new light on the risk of myocardial infarction and mortality associated with subclinical coronary atherosclerosis.