Clinical Use of High-Sensitivity Cardiac Troponin in Patients With Suspected Myocardial Infarction

• Published in: Journal of the American College of Cardiology Vol. 70; no. 8; pp. 996 - 1012
• Main Authors: Twerenbold, Raphael, Boeddinghaus, Jasper, Nestelberger, Thomas, Wildi, Karin, Rubini Gimenez, Maria, Badertscher, Patrick, Mueller, Christian
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 22.08.2017; Elsevier Limited
• Subjects: Acute coronary syndromes; algorithm; Algorithms; Biomarkers - blood; Calcium-binding protein; Cardiology; Cardiomyocytes; Cardiovascular; Cardiovascular disease; diagnostic algorithms; Early Diagnosis; EKG; Electrocardiography; emergency department; Health risk assessment; Heart; Heart attacks; Heart diseases; Heart failure; high-sensitivity cardiac troponin; Humans; Medical diagnosis; Medical prognosis; Myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Pain; Patients; rule-in; rule-out; Survival analysis; Troponin; Troponin I - blood; Troponin T - blood; Europe; NSTEMI; FDA; s-cTn; UA; ADP; rule-out; CCTA; ESC; LBBB; MACE; NPV; PPV; STEMI; hs-cTn; rule-in; MI; high-sensitivity cardiac troponin; algorithm; ED; diagnostic algorithms; CAD; ECG; emergency department; ACS; TIMI; cTn; coronary artery disease; positive predictive value; advanced diagnostic pathway; myocardial infarction; Thrombolysis In Myocardial Infarction; electrocardiogram; acute coronary syndrome; Food and Drug Administration; non–ST-segment elevation myocardial infarction; coronary computed tomography angiography; cardiac troponin; left bundle branch block; major adverse cardiac event(s); European Society of Cardiology; ST-segment elevation myocardial infarction; unstable angina; negative predictive value; sensitive cardiac troponin
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2017.07.718

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 7 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. [Display omitted]