Optimizing High-Sensitivity Cardiac Troponin Use in Suspected Myocardial Infarction
Since their clinical introduction, high-sensitivity cardiac troponin assays have enabled precise quantification of cardiomyocyte injury around the 99th percentile, substantially improving MI detection from blood obtained at emergency department presentation. This precision enabled the development and validation of early diagnostic algorithms that dramatically reduce the time needed for safe MI rule-out or rule-in. The review summarizes key principles for effective hs-cTn use in the emergency setting, emphasizing integration with clinical assessment and ECG findings.
The original study
How to best use high-sensitivity cardiac troponin in patients with suspected myocardial infarction.
- Authors
- Twerenbold R, Boeddinghaus J, Nestelberger T, Wildi K, Rubini Gimenez M, Badertscher P, et al.
- Journal
- Clinical biochemistry
- Type
- Journal Article, Review
- PMID
- 29253510
Original abstract
High-sensitivity cardiac troponin (hs-cTn) assays have been used clinically by thousands of physicians in many countries throughout the world since their clinical introduction seven years ago. In the early diagnosis of myocardial infarction (MI), beyond doubt the most important indication of hs-cTn assays, these simple, inexpensive and highly reproducible tools complement detailed clinical assessment including chest pain characteristics and the electrocardiogram. Hs-cTn assays for the first time allowed the precise quantification of cardiomyocyte injury around the 99th percentile and thereby substantially increased the accuracy of MI detection from blood obtained at presentation to the emergency department (ED). Higher accuracy at ED presentation enabled the development and extensive validation of early hs-cTn-based diagnostic algorithms, which substantially reduced the time required for the safe rule-out or rule-in of MI. This review summarizes key principles underlying the safe and effective use of hs-cTn in the ED in patients with suspected MI.