Distinguishing Acute Cardiac Events from Chronic Troponin Elevation: Integrating High-Sensitivity Troponin Trends with Objective Ischemic Evidence Under the 4th UDMI Across Diverse Renal Function Profiles

Authors

Aidan Fernandez, University of Florida College of MedicineFollow
Amanda Green, University of Florida College of MedicineFollow
Silvija Milanovic, University of Florida College of MedicineFollow
Eric Han, University of Florida College of MedicineFollow
Asia Elbooz, University of Florida College of MedicineFollow
Michael Petrauskis, University of Florida College of MedicineFollow
Justin Nippert, University of Florida Health JacksonvilleFollow
Michael Marchick, University of Florida College of MedicineFollow
Nicholas Maldonado, University of Florida College of MedicineFollow
Mohammed Ruzieh, University of Florida College of MedicineFollow
Elizabeth Warren, University of Florida College of MedicineFollow
Matthew Shaw, University of Florida College of MedicineFollow
Lars Beattie, University of Florida College of MedicineFollow
Brandon Allen, University of Florida College of MedicineFollow

ORCiD

https://orcid.org/0009-0007-6871-4172

Document Type

Original Research

Abstract

The Fourth (4th) Universal Definition of Myocardial Infarction (UDMI) provides a standardized framework to enhance diagnostic accuracy and clinical decision-making. However, challenges can arise due to the use of subjective clinical assessment in diagnostic criteria or in the presence of impaired renal clearance. This study modifies the 4th UDMI by requiring objective ischemic evidence to improve consistency in myocardial infarction (MI) classification and applies it across diverse patient populations.

In this retrospective study, patients who presented to the emergency department (ED) with 99th percentile high sensitivity cardiac troponin (hs-cTn) values were classified using the modified 4th UDMI into the categories of Type 1 MI (T1MI), Type 2 MI (T2MI), acute non-ischemic myocardial injury (NIMI), or chronic NIMI. Patients were also stratified based on estimated glomerular filtration rate (eGFR)

Of the 1,755 qualifying, patients 0.3% (n = 5) were classified as T1MI, 8.2% (n = 145) as T2MI, 22.7% (n = 399) as acute NIMI, and 68.7% (n = 1206) as chronic NIMI. Patients with infarction had a 19.33% mortality rate (29/150), significantly higher than the 7.41% mortality rate (119/1,605) in myocardial injury (p < 0.0001). When stratifying by eGFR, median two-hour troponin levels did not differ significantly. Among the patients with eGFR data, acute NIMI accounted for 378 cases (22.3%), with 82 (21.7%) occurring in the GFR

The consistency of MI and injury classifications across renal function groups supports the validity of the modified 4th UDMI, even in the presence of renal impairment that influences troponin dynamics and patient outcomes.

Recommended Citation

Fernandez, Aidan; Green, Amanda; Milanovic, Silvija; Han, Eric; Elbooz, Asia; Petrauskis, Michael; Nippert, Justin; Marchick, Michael; Maldonado, Nicholas; Ruzieh, Mohammed; Warren, Elizabeth; Shaw, Matthew; Beattie, Lars; and Allen, Brandon (2025) "Distinguishing Acute Cardiac Events from Chronic Troponin Elevation: Integrating High-Sensitivity Troponin Trends with Objective Ischemic Evidence Under the 4th UDMI Across Diverse Renal Function Profiles," Florida Journal of Emergency Medicine (FJEM): Vol. 1.
Available at: https://stars.library.ucf.edu/fjem/vol1/iss1/2