Use of cardiac troponin in the early diagnosis of acute myocardial infarction

Abstract

The diagnosis of coronary artery disease, which is one of the most common causes of death and disability worldwide, still remains a significant problem for clinicians. High‑sensitivity cardiac troponin (hs‑cTn) assays became the cornerstone in the diagnostic workup of acute myocardial infarction. Nowadays, they take an important position in diagnostic algorithms. However, there are still some unexplained issues in this field. This review summarizes and emphasizes the crucial role of hs‑cTn in acute coronary syndromes. The 0/1‑hour hs‑cTn algorithm was mentioned for the first time in the 2015 official European Society of Cardiology guidelines on non–ST‑segment‑elevation acute coronary syndromes. It was derived, validated, and implemented for all clinically‑available assays since then. In this review, troponin‑based strategies for rapid rule‑out or rule‑in of non–ST‑segment elevation myocardial infarction are gathered and compared with the update on the official European Society of Cardiology 0/1‑hour pathway with the most recent values of hs‑cTn. The document also focuses on the problem of possible analytic confounders (false‑ ‑positive and false‑negative results) and compares the usefulness of cTn to other diagnostic techniques (eg, magnetic resonance imaging). The review is divided into short, easy‑to‑read sections emphasizing 6 key messages on how to use and interpret hs‑cTn base algorithms in clinical practice at the emergency department.