High‐Sensitivity Troponin Assays: Evidence, Indications, and Reasonable Use

W ith advances in technology, a new era in troponin assays is approaching. Previous-generation troponin assays have been used as diagnostic and prognostic markers in acute coronary syndrome patients and for risk stratification to guide triage decisions and aid in treatment selection. New, high-sensitivity troponin assays represent an important advance with added sensitivity for cardiac myocyte necrosis, but there remains a need for judicious interpretation with these tests. These new troponin assays could have several distinct roles in clinical practice: (1) facilitation of earlier diagnosis and rule out of myocardial infarction (MI); (2) risk stratification in acute cardiac conditions and prognostic information in stable disease states; and (3) therapeutic monitoring and drug toxicity evaluation. However, because they are not specific for the etiology of cardiac cell death, the clinician has an increasing responsibility to interpret each test in clinical context. When commercially available in the United States (US), these high-sensitivity analyses are expected to offer both advantages and disadvantages to practicing clinicians and to enhance current roles of the troponin assay as well as to open doors to new uses for troponin testing. However, they will also create new challenges in clinical applications, epidemiology, and research. The aim of this review is to discuss the potential clinical and research roles of high-sensitivity cardiac troponin assays and the challenges they may create. Assay Development