Abstract
Cardiac troponin has long been the preferred biomarker for the evaluation of acute coronary syndrome. Successive improvements in analytical performance have significantly enhanced the clinical utility of troponin assays, and the high sensitivity versions now in use are capable of measuring extremely low concentrations of troponin with high precision. Such assays have allowed contraction of the time frame required to confidently rule in and rule out acute myocardial infarction, permitting earlier intervention and earlier discharge, respectively. Robust analytical performance is essential to support clinical decision making, yet high sensitivity troponin assays are afflicted by a range of analytical issues that can undermine their value. These include a high rate of non-reproducible errors, or ‘fliers’, affecting certain assays; a high prevalence of macro-troponin interference affecting multiple assays; and possible loss of cardiac specificity of the troponin T assay in the setting of skeletal muscle disease. This talk will characterise the pitfalls and problems affecting troponin assays, and the risks they confer to patients, laboratories and health care services. Tension between the clinical importance of high sensitivity troponin assays and their analytical shortcomings highlights the need for continued innovation and solutions from our manufacturers.
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