Rapid Diagnostic Algorithms Using High-Sensitivity Troponin: From Evidence to Implementation
High-sensitivity cardiac troponin assays enable measurement well below the 99th percentile with minimal imprecision, permitting the development of accelerated diagnostic algorithms with serial sampling intervals as short as one to two hours. These algorithms predict MI diagnosis with acceptable accuracy compared to traditional 6-12 hour serial sampling approaches. This review addresses both the diagnostic evidence base and the practical aspects of implementing rapid troponin algorithms into routine emergency department workflows.
The original study
Rapid diagnostic strategies using high sensitivity troponin assays: what is the evidence and how should they be implemented?
- Authors
- Collinson P, Dakshi A, Khand A
- Journal
- Annals of clinical biochemistry
- Type
- Journal Article, Review
- PMID
- 35491935
Original abstract
The introduction of high sensitivity measurement of cardiac troponin T (hs cTnT) and cardiac troponin I (hs cTnI) has given the laboratory the ability to measure very low levels of cardiac troponin. The limit of detection of these assays is well below the 99th percentile. These low levels can also be measured with small values of imprecision. A range of algorithms combining presentation measurement with repeat sample intervals of as little as one to 2 hours have been developed. These are able to predict with acceptable accuracy the diagnosis that would be achieved with continued repeat sampling out to six to 12 hours from presentation. In this article, we review the evidence for the diagnostic accuracy of these approaches and the practical aspects of implementation into routine clinical practice.