What is the clinical evidence from this study?

Study design: Case Report. Population: Falsely elevated high-sensitivity cardiac troponin I (n=1). Intervention: Macro-troponin I. Primary outcome: High-sensitivity cardiac troponin I (hs-cTnI) levels.

What does this research mean for the field?

Macro-troponin I complexes can cause falsely and persistently elevated high-sensitivity cardiac troponin I levels due to analytical interference. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To identify the underlying mechanism causing persistent, extreme elevations of high-sensitivity cardiac troponin I that mismatched clinical presentation and other cardiac biomarkers.

July 10, 2026Practical Laboratory MedicineOpen Access

A case report of falsely elevated high-sensitivity cardiac troponin I due to macro-troponin I

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Key result

PEG precipitation resolves false hs-cTnI elevation from macro-troponin I in suspected NSTEMI.

Population

One 54-year-old male patient admitted with acute NSTEMI

Design

Case report

Authors

YSYinfu SunShenzhen Second People's Hospital JSJiawen ShangShenzhen Second People's Hospital WQWeihong QinInstitute of Aging

Discussion

Member takes

Implication

Clinicians should consider macro-troponin in discordant hs-cTnI elevations; case reports leave open optimal detection strategies and prevalence.

Key Points

To identify the underlying mechanism causing persistent, extreme elevations of high-sensitivity cardiac troponin I that mismatched clinical presentation and other cardiac biomarkers.
Evaluated a 54-year-old male admitted with acute non-ST-segment elevation myocardial infarction presenting with sustained hs-cTnI plateau levels (>27404 ng/L).
Performed multi-platform cross-testing across Beckman DXI800, Abbott i2000, and Roche cobas801 systems, alongside serial dilutions and heterophilic antibody blocking.
Conducted polyethylene glycol (PEG) precipitation to detect the presence of high-molecular-weight troponin complexes.
Emergency coronary angiography revealed only 70% segmental distal stenosis with TIMI III flow, contrasting sharply with Beckman hs-cTnI at 28107 ng/l (1606.11-fold increase) and Abbott hs-cTnI at 38405 ng/l (1465.84-fold increase), whereas Roche hs-cTnT was 74.6 ng/l (5.33-fold increase).
Heterophilic antibody blocking agents and alkaline phosphatase inhibitors had no effect, and rheumatoid factor screening was negative.
Polyethylene glycol precipitation dramatically decreased hs-cTnI to normal levels, confirming that the persistent plateau (>27404 ng/L) was caused by macro-cardiac troponin I interference.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 54-year-old male patient with suspected NSTEMI who exhibited falsely elevated high-sensitivity cardiac troponin I levels due to macro-troponin I interference.

Exposure

Systematic laboratory verification including multi-platform assay comparison, serial dilution, polyethylene glycol (PEG) precipitation, and heterophilic antibody blocking agents

Outcome

Identification of the cause of falsely elevated high-sensitivity cardiac troponin I (hs-cTnI)surrogate

Persistently elevated hs-cTnI that is discordant with clinical presentation and other cardiac biomarkers should raise suspicion for macro-troponin interference, which can be confirmed using PEG precipitation.

Cite This Study

Sun et al. (2026) conducted a case report in Falsely elevated high-sensitivity cardiac troponin I (n=1). Macro-troponin I was evaluated on High-sensitivity cardiac troponin I (hs-cTnI) levels. Macro-troponin I caused falsely elevated high-sensitivity cardiac troponin I levels (>27,404 ng/L) in a patient with suspected NSTEMI, which were corrected to 148 ng/L following polyethylene glycol precipitation.

synapsesocial.com/papers/6a508d536eeac72a437a0d7b https://doi.org/10.1016/j.plabm.2026.e00546

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Implication

Clinicians should consider macro-troponin in discordant hs-cTnI elevations; case reports leave open optimal detection strategies and prevalence.

A case report of falsely elevated high-sensitivity cardiac troponin I due to macro-troponin I

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

A case report of falsely elevated high-sensitivity cardiac troponin I due to macro-troponin I

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Also Consider