What is the best approach for managing elevated troponin without ST-segment elevation?

Managing elevated troponin levels without ST-segment elevation typically indicates the presence of myocardial injury or strain, which may not necessarily point to an acute myocardial infarction requiring immediate invasive interventions. The most appropriate approach in such cases is medical management with antiplatelet therapy.

Antiplatelet medications play a crucial role in preventing further thrombus formation in situations where there is myocardial ischemia due to unstable coronary artery disease. By using antiplatelet therapy, the aim is to stabilize the plaque and reduce the risk of progression to a full-blown myocardial infarction.

Invasive coronary angiography is generally more suitable for patients with suspected acute coronary syndrome who exhibit clear indications, such as ongoing ST-segment elevation or angina that is unresponsive to initial medical management. In the absence of acute findings, this approach may not be warranted.

Fibrinolytic therapy is typically reserved for situations with ST-segment elevation, where there is a need to dissolve thrombus occluding a coronary artery rapidly. Its use in cases without ST-segment elevation is not appropriate due to the risk of bleeding and the lack of evidence supporting its efficacy in this context.

Elective surgery would not be the best management strategy for elevated troponin levels without an acute