High-Sensitivity Cardiac Troponin Assays: Ready for Prime Time!

Abstract

Rapid and accurate triage of patients presenting with chest pain to an emergency department (ED) is critical to prevent ED overcrowding and unnecessary resource use in individuals at low risk of acute myocardial infarction (AMI) and to efficiently and effectively guide patients at high risk to definite therapy. The use of biomarkers for rule-out or rule-in of suspected AMI has evolved substantially over the last several decades. Previously well-established biomarkers have been replaced by cardiac troponin (cTn). High-sensitivity cTn (hs-cTn) assays represent the newest generation of cTn assays and offer tremendous advantages, including improved sensitivity and precision. Still, implementation of these assays in the United States lags behind several other areas of the world. Within this educational review, we discuss the evolution of biomarker testing for detection of myocardial injury, address the specifics of hs-cTn assays and their recommended use within triage algorithms, and highlight potential challenges in their use. Ultimately, we focus on implementation strategies for hs-cTn assays, as they are now clearly ready for prime time. Expected final online publication date for the Annual Review of Medicine, Volume 75 is January 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Optimizing the Clinical Use of High-Sensitivity Troponin Assays: A Review

“…This algorithm is illustrated in Figure 1 . Over the recent years, high-sensitivity cardiac troponin (hs-cTn) assays have revolutionized the assessment of myocardial stress and injury due to their superior sensitivity and accuracy in detecting even minor cardiac damage [ 5 ]. Patients with STEMI or very high-risk non-STEMI do not need troponin for diagnosis, but their management should not be delayed by waiting for troponin results to be available.…”