Macrotroponin Complexes and Risk of Cardiovascular Events.

Macrotroponin complexes explain most discordant elevated cardiac troponin I and a smaller share of discordant cardiac troponin T in a general population cohort, with 92.5% and 15.4% respectively.

• Why it matters: Abnormal cardiac troponin values are used for cardiovascular risk prediction, but assay interference and altered clearance can distort results, making the true frequency and prognostic impact unclear.
• What they did: Participants with both cardiac troponin I and T measurements (n=19 499) were classified as no myocardial injury, suspected macrotroponin, or myocardial injury; macrotroponin was confirmed in a subset (n=203) using immunoglobulin depletion and ultracentrifugation, then Cox models tested future events.
• The result: Myocardial injury predicted higher future myocardial infarction, ischemic stroke, or cardiovascular death (troponin I adjusted HR 2.90; troponin T adjusted HR 1.99), while suspected macrotroponin showed similar risk to no elevation (troponin I adjusted HR 1.59; troponin T adjusted HR 1.27), with similar findings in replication.

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