The American College of Cardiology recently published a short review of the role of biomarker testing in patients with COVID-19. It states that “clinicians are advised to only measure troponin if the diagnosis of acute myocardial infarction is being considered on clinical grounds." This approach was recommended on the basis that troponin elevation in patients with COVID-19 is likely to be multifactorial and less likely to be attributable to atherothrombotic coronary occlusion.
Circulating cardiac troponin is a marker of myocardial injury, including but not limited to myocardial infarction or myocarditis, and the clinical relevance of this distinction has never been so clear. Clinicians who have used troponin measurement as a binary test for myocardial infarction independent of clinical context and those who consider an elevated cardiac troponin concentration to be a mandate for invasive coronary angiography must recalibrate. Rather than encouraging avoidance of troponin testing, we must harness the unheralded engagement from the cardiovascular community attributable to COVID-19 to better understand the usefulness of this essential biomarker and to educate clinicians on its interpretation and implications for prognosis and clinical decision making.
Chapman, A., Bularga, A. & Mills, N. 2020, 'High-Sensitivity Cardiac Troponin Can Be An Ally in the Fight Against COVID-19', Circulation, 141(22), pp. 1733-1735. https://doi.org/10.1161/CIRCULATIONAHA.120.047008