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High-Sensitivity Troponin in Suspected Acute Coronary Syndrome: What General Cardiologists Need to Know

Take home messages

  • High sensitivity troponin (hscTn) assays increase diagnostic yield and improve outcomes in non-ischaemic myocardial injuries, but not in those with a final diagnosis of AMI.
  • Assay choice matters operationally (cross-reactivity with hs-cTnT in skeletal myopathy; macrotroponin artefact with cTnI), but there is no definitive RCT proving clinical superiority of T vs I.
  • 0/1-hour algorithms are safe and efficient with hs-cTn; they detect more early MIs, but real-world gains in length of stay are modest.
  • Troponin release kinetics cannot reliably distinguish aetiology.
  • A rule out threshold below the Limit of detection (LoD) is a powerful tool to streamline care while preserving safety. Some have postulated using it to refine the diagnosis of unstable angina.
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Author

  • Sub-editor:

    Dr Michael Campbell obtained his primary medical degree at the University of Bristol and holds an intercalated degree in Clinical Cardiovascular Sciences from the University of Glasgow. He completed his post graduate certificate in medical education with Queen’s University Belfast with whom he is a sub deanery teaching fellow. He is currently a Cardiology Specialty Resident Doctor Registrar (ST5) in the Northern Ireland deanery. His subspecialty interest is in interventional cardiology. His previous research interests include haemostasis and cardiac biomarkers.

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