High-Sensitivity Troponin Assays Enable Rapid Rule-Out in Acute Coronary Syndromes
This Lancet seminar provides a comprehensive overview of acute coronary syndrome pathobiology, diagnosis, and management, with emphasis on how high-sensitivity troponin assays have transformed emergency evaluation by enabling rapid rule-out protocols for NSTEMI. The review also addresses the impact of the COVID-19 pandemic on ACS care pathways and reinforces the importance of dual antiplatelet therapy and intensive lipid-lowering to LDL-C below 1.4 mmol/L.
The original study
Acute coronary syndromes.
- Authors
- Bergmark BA, Mathenge N, Merlini PA, Lawrence-Wright MB, Giugliano RP
- Journal
- Lancet (London, England)
- Type
- Journal Article, Review
- PMID
- 35367005
Original abstract
Although substantial progress has been made in the diagnosis and treatment of acute coronary syndromes, cardiovascular disease remains the leading cause of death globally, with nearly half of these deaths due to ischaemic heart disease. The broadening availability of high-sensitivity troponin assays has allowed for rapid rule-out algorithms in patients with suspected non-ST-segment elevated myocardial infarction (NSTEMI). Dual antiplatelet therapy is recommended for 12 months following an acute coronary syndrome in most patients, and additional secondary prevention measures including intensive lipid-lowering therapy (LDL-C <1·4 mmol/L), neurohormonal agents, and lifestyle modification, are crucial. The scientific evidence for diagnosis and management of acute coronary syndromes continues to evolve rapidly, including adapting to the COVID-19 pandemic, which has impacted all aspects of care. This Seminar provides a clinically relevant overview of the pathobiology, diagnosis, and management of acute coronary syndromes, and describes key scientific advances.