Use of the newer high-sensitivity troponins offer significant advantages, but with a number of caveats. Although the ability to accelerate the exclusion of myocardial infarction in many patients within just a few hours of ED presentation, the increased sensitivity can potentially lead to diagnostic confusion as more patients will have detectable troponin indicating myocardial injury not associated myocardial infarction.

In this interview, Michael C Kontos, MD, FACC, Ana Barac MD, PhD, FACC, with Aaysha Cader, MBBS, MD, MRCP, discuss High-Sensitivity Troponin in The ED: Pearls And Pitfalls of Wide-spread Utilization.

Related Resources

• Could High-Sensitivity Cardiac Troponin Testing Rule Out Acute Myocardial Infarction in the Prehospital Setting? | Journal of the American College of Cardiology
• Poll Results: Use of High-Sensitivity Troponin
• High-Sensitivity Cardiac Troponin on Presentation to Rule Out MI
• Cover Story | Chest Pain Evaluation, Diagnosis at Heart of New AHA/ACC Guideline

References

1. Cooper JG, Ferguson J, Donaldson LA, et al. Could High-Sensitivity Cardiac Troponin Testing Rule Out Acute Myocardial Infarction in the Prehospital Setting? J Am Coll Cardiol 2021;78(23): 2392–2394.
2. Januzzi JL Jr, Mahler SA, Christenson RH, et al. Recommendations for Institutions Transitioning to High-Sensitivity Troponin Testing: JACC Scientific Expert Panel. J Am Coll Cardiol 2019;73(9):1059-1077.
3. Apple FS, Collinson PO, Kavsak PA, et al., IFCC Committee on Clinical Applications of Cardiac Bio-Markers. Getting Cardiac Troponin Right: Appraisal of the 2020 European Society of Cardiology Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation by the International Federation of Clinical Chemistry and Laboratory Medicine Committee on Clinical Applications of Cardiac Bio-Markers. Clin Chem 2021;67(5):730-735.
4. Wu AHB, Christenson RH, Greene DN, et al. Clinical Laboratory Practice Recommendations for the Use of Cardiac Troponin in Acute Coronary Syndrome: Expert Opinion from the Academy of the American Association for Clinical Chemistry and the Task Force on Clinical Applications of Cardiac Bio-Markers of the International Federation of Clinical Chemistry and Laboratory Medicine. Clin Chem 2018;64(4):645-655.
5. McCarthy CP, Raber I, Chapman AR, et al. Myocardial Injury in the Era of High-Sensitivity Cardiac Troponin Assays: A Practical Approach for Clinicians. JAMA Cardiol 2019; 4(10):1034-1042.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Noninvasive Imaging

Keywords: ACCELLite, Troponin, Myocardial Infarction, Emergency Service, Hospital

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