Troponin: more lessons to learn

Abstract

This editorial refers to ‘Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays’, by P. Haaf et al. doi:10.1093/eurheartj/eht218 Cardiac troponin entered our diagnostic armamentarium 20 years ago and—unlike any other biomarker—is going through constant expansion in its application. Troponin started out as a marker of risk in ‘unstable angina’, then was used as gold standard for risk stratification and therapy guiding in acute coronary syndrome (ACS) patients, served further to redefine myocardial infarction, and has finally also become a risk factor in apparently healthy subjects.1–6 The recently introduced high-sensitivity cardiac troponin (hs-cTn) assays have not only expanded the potential of troponins, but have also resulted in a certain amount of confusion among unprepared users. After many years of scepticism, troponins were accepted as the gold standard for patients with chest pain by classifying them into troponin-positive and troponin-negative patients. The new generation of hs-cTn assays has improved the accuracy at the lower limit of detection and provided incremental diagnostic information especially in the early phase of myocardial infarction.7 Moreover, low levels of measurable troponins unrelated to ACS have been associated with an adverse long-term outcome. Several studies demonstrated that these low levels of cardiac troponin measurable only by hs-cTn assays are able to predict mortality in patients with ACS as well as in patients with assumed stable coronary artery disease.6,8 Furthermore, hs-cTn has the potential to play a role in care of patients undergoing non-cardiac surgery.9 The additional determination of hs-cTnT improves perioperative risk stratification despite established risk scores providing both diagnostic and prognostic information. The daily clinical challenge in using …