Incorporating high-sensitivity cardiac troponin assays into clinical practice: these assays are your friend

The objective of this review is to provide an overview of the current analytical, clinical, and risk assessment status of cardiac troponin (cTn) high-sensitivity (hs) assays and on how to better understand their use in clinical practice. The introduction of hs-cTnI and hs-cTnT assays into clinical practice has enabled improved diagnostic accuracy using serial changes. However, there remains substantial investigative work to be done before coherent evidence-based guidelines can be established for the full spectrum of available assays. Not all cTn assays, I or T, are alike, whether contemporary sensitive or high-sensitivity. Each assay and each platform on which cTn is measured requires development of its own evidencebased delta criteria in order to support optimal use for patients presenting with symptoms suggestive of ischemia. The growth in utilization of hs-cTn assays will both improve diagnostics for early rule in and early rule out of patients presenting with symptoms suggestive of acute coronary syndrome (ACS). As for patients with non-ACS presentation and for primary and or secondary prevention for risk assessment, future therapeutic studies will best define the power of hs-cTn assays and their role in clinical practice. However, what we do know is that an increased cTn concentration indicates a poor outcome and need for increased clinical vigilance. L Heart Metab. 2015;67:9-14