Key result
Macrotroponin complexes drive false-positive persistently elevated hs-cTnI in a patient with atypical chest pain.
Why the study?
While high-sensitivity cardiac troponins are the gold standard for diagnosing acute myocardial infarction and myocardial injury, false positives can occur and present diagnostic challenges.
Case Report (n=1)
No
Persistently elevated high-sensitivity troponin levels in the absence of clinical or imaging evidence of myocardial injury should prompt investigation for false positives, such as macrotroponinemia.
May warrant macrotroponin evaluation for unexplained hs-TnI elevations; case report leaves open prevalence and testing algorithms.
High-sensitivity cardiac troponins are considered a gold standard for diagnosing acute myocardial infarction and myocardial injury. However, the occurrence of false positives needs to be kept in mind. We describe the clinical challenges in diagnosing a 45-year-old woman who repeatedly presented to the emergency department with atypical chest pain and extremely elevated high sensitivity troponin I (HsTnI), despite normal imaging including cardiac MRIs and invasive coronary angiograms, on multiple occasions. This report emphasizes the importance of carefully interpreting elevated troponin levels, especially when clinical findings and further investigations do not support a cardiac origin for troponin (Tn) elevation.
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Narayanan et al. (2025) conducted a case report in Atypical chest pain with elevated high-sensitivity troponin I (n=1). COVID-19 vaccine was evaluated on Presence of macrotroponin complexes. Persistently elevated high-sensitivity troponin I in a 45-year-old woman with atypical chest pain was identified as a false positive due to macrotroponin complexes, highlighting the risk of misdiagnosis.
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