March 19, 2021

Introduction: Chest pain is a common reason or presentation to the Emergency Department (ED). Emergency physicians are often challenged to identify patients who are at high risk for an acute coronary syndrome (ACS), from those with low risk, who might benefit from early discharge without extensive diagnostic workup. The introduction of high sensitivity cardiac troponins have improved early rule out strategies. Previous studies on high sensitivity troponins (hs-cTnT) have yielded two risk stratification strategies for rule in / rule out of myocardial infarction (MI); using an initial hs-cTnT below the limit of quantification (LOQ) alone and using an algorithm with initial and 1-hour hs-cTNT (0/1-h algorithm), as currently recommended by the European Society of Cardiology. These strategies are often combined with a risk score, of which in the United States (US) the HEART score is the most commonly used. However, due to the relatively late introduction of hs-cTnT in the US, multicenter US data for these risk stratification strategies using hs-cTnT are lacking. The goal of the current study was to prospectively evaluate the diagnostic performance of a hs-cTnT assay (Roche, Basel Switzerland) for the detection of 30-day MACE using two different strategies: an initial hs-cTnT <LOQ alone and a 0/1-h algorithm, both with and without clinical variables (ECG interpretation and HEART score).

February 6, 2014

Troponin testing is an important component of the diagnostic workup and management of acute coronary syndromes (ACS). The increasing sensitivity of troponin assays has lowered the number of potentially missed ACS diagnoses, but this has also created a diagnostic challenge due to a decrease in the specificity of the test. From 1995 to 2007, the limit of troponin detection fell from 0.5 ng/mL to 0.006 ng/mL (see below graph). Robert Jesse summed up this frustration with the following quote:
When troponin was a lousy assay it was a great test, but now that it's becoming a great assay, it's getting to be a lousy test.