Highly sensitive troponin and diagnostic accuracy in acute myocardial infarction

Abstract

Chest pain is one of the most common reasons for which patients seek care in the emergency department. When evaluating these patients, much effort is made to recognize cardiac causes of chest pain, in particular acute coronary syndrome (ACS), and to identify high-risk patients who may benefit from more aggressive treatments. Cardiac troponins play a pivotal role for this purpose. The diagnosis of acute myocardial infarction (AMI) is based mainly on an elevated cardiac troponin level exceeding the 99th percentile; this since 2000, when the joint committee of the European Society of Cardiology and the American College of Cardiology (ESC/ACC) published a new definition of AMI that for the first time officially included these biomarkers [1]. Recently introduced high-sensitivity troponin assays have improved the early diagnosis of acute myocardial infarction, and have a pivotal role in diagnosis, risk stratification, and management of patients with acute coronary syndromes [2–4], but their ideal cut-off and critical changes are yet to be established. Moreover, in clinical practice, the use of troponin high sensitivity is likely to increase the number of false-positive results. Summary