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World J Cardiol. Apr 26, 2014; 6(4): 175-182
Published online Apr 26, 2014. doi: 10.4330/wjc.v6.i4.175
High-sensitivity cardiac troponins in everyday clinical practice
Johannes Mair
Johannes Mair, Department of Internal Medicine III, Cardiology and Angiology, Innsbruck Medical University, A-6020 Innsbruck, Austria
Author contributions: Mair J solely contributed to this paper.
Correspondence to: Johannes Mair, MD, Associate Professor, Department of Internal Medicine III, Cardiology and Angiology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria. johannes.mair@i-med.ac.at
Telephone: +43-512-50481314 Fax: +43-512-50422767
Received: November 10, 2013
Revised: February 15, 2014
Accepted: March 13, 2014
Published online: April 26, 2014
Processing time: 164 Days and 23.8 Hours
Abstract

High-sensitivity cardiac troponin (hs-cTn) assays are increasingly being used in many countries worldwide, however, a generally accepted definition of high-sensitivity is still pending. These assays enable cTn measurement with a high degree of analytical sensitivity with a low analytical imprecision at the low measuring range of cTn assays (coefficient of variation of < 10% at the 99th percentile upper reference limit). One of the most important advantages of these new assays is that they allow novel, more rapid approaches to rule in or rule out acute coronary syndromes (ACSs) than with previous cTn assay generations which are still more commonly used in practice worldwide. hs-cTn is also more sensitive for the detection of myocardial damage unrelated to acute myocardial ischemia. Therefore, the increase in early diagnostic sensitivity of hs-cTn assays for ACS comes at the cost of a reduced ACS specificity, because more patients with other causes of acute or chronic myocardial injury without overt myocardial ischemia are detected than with previous cTn assays. As hs-cTn assays are increasingly being adopted in clinical practice and more hs-cTn assays are being developed, this review attempts to synthesize the available clinical data to make recommendations for their everyday clinical routine use.

Keywords: Cardiac troponin; High-sensitivity; Diagnosis; Acute myocardial infarction; Acute coronary syndrome; Review

Core tip: High-sensitivity cardiac troponin (hs-cTn) assays enable cardiac troponin measurement with a high degree of analytical sensitivity with a low analytical imprecision at the low measuring range. One of the most important advantages of these new assays is that they allow novel, more rapid approaches to rule in or rule out acute coronary syndromes (ACSs). The increase in early diagnostic sensitivity of hs-cTn assays for ACS comes at the cost of a reduced ACS specificity, because more patients with other causes of acute or chronic myocardial injury without overt myocardial ischemia are detected than with previous cTn assays.